The Part D Claims Eligibility Specialist is responsible for handling claims and compliance activities for the InnovAge Part D plan. The role includes managing and reconciling Part A claims and stays, maintaining participant plan enrollment status with the pharmacy and PBM, ensuring claims are billed appropriately under Part D based on CMS regulations and EMR documentation, and collaborating with Medicare, Medicaid, finance, and billing teams.
This is a work-from-home position.
Applicants should have at least 3 years of experience working with medical and/or pharmacy claims. Strong knowledge of medication names, dosages, indications, and routes of administration is required.
Other qualifications include:
- Experience navigating EMR systems and interpreting EMR data
- Advanced Excel skills, including formulas, pivot tables, and reporting
- Ability to solve problems under pressure
- Strong attention to detail and the ability to prioritize workload
- Ability to work independently
- Excellent communication and organization skills
- Strong computer skills with word processors, spreadsheets, and database software
- Associate's degree or formal training beyond high school in lieu of an associate degree
Preferred qualifications:
- Bachelor's degree
- Experience with EPIC EMR
- Experience managing patient plan eligibility
- Experience in a PACE or similar healthcare program
- Knowledge of Medicare Part D regulations and compliance requirements
InnovAge offers a comprehensive benefits package that includes:
- Medical, dental, and vision insurance
- Short- and long-term disability coverage
- Life insurance and AD&D
- Supplemental life insurance
- Flexible spending accounts
- 401(k) savings plan with company match
- Paid time off
- Company-paid holidays
Location
Denver, Colorado, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
Yes
Posted
3 weeks ago