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The Senior Manager serves as a key leader responsible for ensuring the accuracy, compliance, and operational integrity of the organization's Medicare Part D programs -- Medicare Advantage, SSIC, DSNP, and MMP programs. Operating as a highly visible subject matter expert, this role manages critical CMS Part D reporting requirements, and provides strategic guidance on regulatory and financial matters that directly influence enterprise performance of Part D. This individual contributor role will routinely partner with Compliance, Finance, Audit, Pharmacy Operations, and external stakeholders including the PBM to resolve complex issues, strengthen operational controls, and ensure adherence to CMS standards for our Part D programs. The Senior Manager also contributes to automation, data governance, and ETL optimization initiatives to enhance efficiency and reliability of enterprise reporting and accuracy of Part D.
Job Responsibility:
Oversee annual and ongoing CMS Part D submissions, including PDE and HPMS attestation requirements
Ensure alignment with evolving CMS Part D guidance by coordinating with Compliance and Operational Integrity teams and our PBM
Lead and assist in annual reporting, testing, and validation efforts of Part D for PDE, claims, LEP, MSP, COB, and rebate workflows
Assist in managing resolution of Acumen PDE tickets, ensuring timely and accurate responses
Partner with Pharmacy Operations teams on PBM-related issues, including Service Warranty reviews and SWAT investigations
Provide mentorship and guidance to associates, fostering skills in analysis, regulatory compliance, and Medicare Part D operations
Collaborate with internal leaders and external partners to ensure consistent understanding of regulatory requirements for Part D
Synthesize complex data into clear, meaningful insights for senior leadership and Compliance partners
Lead analytical reviews related to CMS PDE submissions and reconciliations to paid claims data
Identify opportunities to optimize accuracy, improve internal controls, and streamline operational processes for Part D PDE submissions
Requirements:
7+ years of professional experience
Strong financial reporting and financial analysis experience
Proficiency with SAS/SQL, Python, GCP, and advanced data management tools
Demonstrated ability to interpret complex datasets and translate findings into actionable recommendations
Strong analytical, mathematical, and problem-solving abilities
Bachelor's degree in Finance, Accounting, or a related discipline, or equivalent years of experience
Nice to have:
Experience in Medicare Part D accounting, financial operations, or regulatory compliance
5+ years of Medicare Part D finance experience with expertise in data mining, analytics, and operational improvement
Experience supporting or leading compliance activities within a health plan or regulated environment