Megan Davis Email and Phone Number
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.
Prime Therapeutics
View- Website:
- primetherapeutics.com
- Employees:
- 5988
-
Director Regulatory And Audit ResponsePrime TherapeuticsOrlando, Fl, Us -
Director Regulatory & Audit ResponsePrime Therapeutics May 2020 - PresentEagan, Minnesota, United StatesProvide 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. -
Compliance ManagerPrime Therapeutics Sep 2016 - May 2020Eagan, MnLead 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. -
Functional Business ConsultantPrime Therapeutics Sep 2015 - Sep 2016Eagan, MnServe 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. -
Sr. Government Programs Compliance SpecialistPrime Therapeutics Jun 2013 - Sep 2015Eagan, MnCreate, 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. -
Medicare Research SpecialistPrime Therapeutics Mar 2012 - May 2013Greater Omaha AreaMaintain 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. -
Associate Medicare Member Research SpecialistPrime Therapeutics Sep 2011 - Mar 2012Greater Omaha AreaEnsured 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. -
Member Service AgentPrime Therapeutics May 2011 - Sep 2011Greater Omaha AreaConsistently 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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