Megan Davis

Megan Davis Email and Phone Number

Director Regulatory and Audit Response @ Prime Therapeutics
Orlando, FL, US
Megan Davis's Location
Port Washington, New York, United States, United States
About Megan Davis

As a Director Regulatory & Audit Response at Prime Therapeutics, I provide strategic direction, development, and leadership within Clinical Operations to ensure regulatory compliance and client satisfaction. With over 14 years of experience in the health care industry, I have a broad knowledge of Commercial, HIM, Medicaid, Medicare Parts B and D and accreditation requirements, as well as a strong background in quality, training, audits, and risk assessments.I am a Certified Compliance & Ethics Professional (CCEP) and a subject matter expert in government programs benefits and formulary, coverage determination and appeals, and regulatory adherence. I have successfully coordinated and executed multiple projects related to the compliance program and associated work plans, collaborated with internal and external stakeholders, and produced improvement strategies to existing processes. I am passionate about improving team performance and company statistics, and excel in written and verbal communication with the ability to effectively manage continuous change.

Megan Davis's Current Company Details
Prime Therapeutics

Prime Therapeutics

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Director Regulatory and Audit Response
Orlando, FL, US
Employees:
5988
Megan Davis Work Experience Details
  • Prime Therapeutics
    Director Regulatory And Audit Response
    Prime Therapeutics
    Orlando, Fl, Us
  • Prime Therapeutics
    Director Regulatory & Audit Response
    Prime Therapeutics May 2020 - Present
    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.
  • Prime Therapeutics
    Compliance Manager
    Prime Therapeutics Sep 2016 - May 2020
    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.
  • Prime Therapeutics
    Functional Business Consultant
    Prime Therapeutics Sep 2015 - Sep 2016
    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.
  • Prime Therapeutics
    Sr. Government Programs Compliance Specialist
    Prime Therapeutics Jun 2013 - Sep 2015
    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.
  • Prime Therapeutics
    Medicare Research Specialist
    Prime Therapeutics Mar 2012 - May 2013
    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.
  • Prime Therapeutics
    Associate Medicare Member Research Specialist
    Prime Therapeutics Sep 2011 - Mar 2012
    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.
  • Prime Therapeutics
    Member Service Agent
    Prime Therapeutics May 2011 - Sep 2011
    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.

Frequently Asked Questions about Megan Davis

What company does Megan Davis work for?

Megan Davis works for Prime Therapeutics

What is Megan Davis's role at the current company?

Megan Davis's current role is Director Regulatory and Audit Response.

Who are Megan Davis's colleagues?

Megan Davis's colleagues are Tyler Patton, Hawua Santuraki, Gloria Ramos, Sam Cocchiarella, Brian Clark, Todd Johnson, Ellen Morrison.

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