Megan Davis Email & Phone Number

Orlando, Fl, Us

Eagan, Minnesota, United States

Provide strategic direction, development and leadership within Clinical Operations' Regulatory & Audit Response team in support of Medicare Part D coverage determination, Medicare Part B organization determination, and prior authorization effectuation process to ensure regulatory compliance.. Align operation activities with corresponding requirements (including CMS, State, contractual, and Accreditation), and measure/demonstrate results as represented through audit by external client, federal authority, or accreditation entity.

Eagan, Mn

Lead day to day operations of compliance team professionals with the purpose of executing a strong compliance program. Oversee resources, schedules, and performance of compliance professionals. Coordinate an array of projects related to the compliance program and associated work plans. Collaborate with internal and external strategy for confident attestation of regulatory requirements. Oversee vendor management compliance. Produce improvement strategy to existing processes ensuring efficiency and effectiveness. Provide leadership in identifying and adopting best practices and standard operating procedures as it relates to regulatory guidance.

Eagan, Mn

Serve as a subject matter expert, with Government Programs Benefits & Formulary area. High level of understanding to specific business system and business process. Represent benefits and formulary with emphasis in the area of transition benefit expertise. Working knowledge regarding business system knowledge on internal and client projects, regulatory requirements, process improvements, advanced researcher, root cause analyst, complex issue resolver, documenter,effective communicator, frequent client interaction, tester, ongoing system supporter, and developer of reports and coordinating audit efforts.

Eagan, Mn

Create, implement, manage and maintain process for day to day activities surrounding a distinctive complex benefit. Maintain and improve process for formulary change transitions for Medicare Part D members. Create and modify Standard Operating Procedures. Coordinate the Annual Formulary Change Transition mailing for existing members. Maintain compliance with applicable governing organizations guidance. Act as subject matter expert for formulary and transition audit processes.

Greater Omaha Area

Maintain working knowledge of expectations of members and clients. Research and resolve CTMs, inquiries, and grievances regarding benefits, services, and pharmacy claims. Ensure consistent team improvement and development. Assist with audits and quality review.

Greater Omaha Area

Ensured member benefits applied appropriately. Researched member claims and responded to questions. Provided member documentation upon request. Worked with client to ensure member information updated as needed. Maintained turnaround times as dictated by internal and external partners.

Greater Omaha Area

Consistently provide excellent customer service by assisting members with pharmacy benefit questions and concerns. Ensure compliance with HIPAA, CMS, and Company guidelines.