Miru Monte is a Senior Consultant at Gorman Health Group (GHG). In this role, she has supported projects for formulary and benefit administration, Centers for Medicare & Medicaid Services (CMS) audit preparation, Pharmacy Benefit Manager (PBM) implementations, and delegation oversight policies. Miru brings GHG clients an extensive background in Medicare Part D – from a benefits and formulary implementation perspective to general PBM operations.
Miru’s comprehensive knowledge and proficiency with respect to Medicare Part D extends to formulary configuration and analysis, benefit design and testing, claims processing, data management, reporting, prescription drug event, member Explanation of Benefits, and other Medicare-required programs and audits.
Prior to her role at GHG, Miru held a management position in Medicare Part D formulary implementations for a leading PBM, overseeing various projects and workflows in support of the Medicare formulary and benefit implementation for numerous health plans. She brings extensive expertise to clients in the areas of benefits and formulary configuration and data analytics for Medicare Part D with a primary focus on quality assurance and benefits testing. She has successfully supported formulary development and analytics, Health Plan Management System (HPMS) formulary submissions, and CMS audit preparations for Medicare Advantage Prescription Drug Plans (MA-PDs), Prescription Drug Plans (PDPs), and Employer Group Waiver Plans (EGWPs). Miru provides invaluable support to the GHG Pharmacy team through her insight of operational implementation of CMS guidance, policy and procedure compilation, compliance oversight, and auditing.
In addition to her expertise in Medicare, Miru has assisted the Medicaid and commercial books of business through quality initiatives for comprehensive formulary testing/ automation development, targeted claim analytics, claim processor code developments, and quality assurance of client migrations and implementations.