Late Enrollment Penalty Analyst

Position Purpose: Conducts Medicare prescription drug non-medical reconsideration decisions or Late Enrollment Penalty (LEP) decisions.

Essential Responsibilities: Writes a non-medical prescription drug reconsideration or LEP decision that is clear and supports the determination made. Ensures that all appeal issues raised have been researched and addressed. Provides a fair and impartial decision based on the presentation of facts, Centers for Medicare & Medicaid Service (CMS) regulations and policies, and Health Plan formulary rules or other relevant information. Ensures all documents are releasable and do not violate any Privacy Act provisions. Conducts research using online federal regulations and Medicare policy provisions, Health Plan formulary policies or subscriber materials, and CMS systems including the Health Plan Management System (HPMS) and the Medicare Appeals System (MAS), to complete accurate and well-supported decisions. Makes sound, independent decisions based on the submitted evidence in accordance with CMS regulations and policies, and Health Plan formularies and/or subscriber materials.

Education: High School Diploma or equivalent

Experience: Two (2) years of general office experience College education or technical training in administration, business, or related areas may be substituted for experience on a year per year basis. (Education requirements may be satisfied by full-time education or the prorated part-time equivalent.)Experience directly relevant to Part D Late Enrollment Penalty appeals, preferred Resided in the United States for a minimum of three (3) years out of the last five (5) years (Per Contract Requirement)