Peak TPA (Peak), a Tabula Rasa Healthcare company, helps PACE organizations manage the business functions that drive the major sources of reimbursement revenue and utilization costs. Peak provides services that optimize financial management and fulfill regulatory requirements for health plan functions. Peak is committed to the PACE model of care and thus to the success of the sponsoring organizations.
Peak is seeking a detail-oriented, knowledgable team member to fill the role of Data Submission Coordinator.
Under the supervision of the Regulatory Manager, the Data Submission Coordinator is responsible for submitting Risk Adjustment Data, PDE, and Encounter data for all clients. The Data Submission Coordinator is also responsible for the reporting and regulatory functions as described below.
Medicare Part D
Import pharmacy files into PACElogic System monthly - all clients
Submit PDE file to CMS monthly - all clients
Correct PDE files & re-submit to CMS as needed - all clients
Submit PDE return files to PDAC - all clients
Create PDE status report - all clients
Correct PDE data necessary based on results of audit
Check P2P reports monthly - all clients
Complete P2P approval form as needed - all clients
Complete Part D reserve worksheet monthly - all clients
Calculate TrOOP for all disenrollments monthly - all clients
Generate & mail TrOOP notification monthly - all clients
Place TrOOP notification on FTP site - all clients
Part D Audit
Review all Part A stays for clients and validate no drugs were filled under Medicare Part D during the stays - all clients
Track all regulatory submissions and dates for clients
Communicates clearly and concisely, with sensitivity to the needs of others
Maintains courteous, helpful and professional behavior on the job; displays a willingness and ability to be responsive in a warm and caring manner to all customer groups; consistently cooperates and supports organization in problem solving issues; ensures customer satisfaction by understanding and applying the Customer Service Policy, Procedure and Standards; will support the success of the entire team; establishes and maintains effective working relationships with co-workers
Follows all Policies and Procedures and HIPAA regulations
Maintains a safe working environment
Maintains knowledge and understanding of current Medicare regulations related to PACE health plan management
Maintains the confidentiality of all company procedures, results, and information about participants, clients, providers and employees
Supervisory Responsibility: None
Travel: Minimal travel, less than 10% is expected for this position. For remote positions, travel is required for initial training and for necessary, subsequent training. Travel may also be required for company events.
Knowledge, Skills and Abilities:
Physical Demands & Requirements:
This position is currently not accepting applications.
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