Mgr Medicare Part D Pharmacy Programs - Remote, Pennsylvania

Our work matters. We help people get the medicine they need to feel better and live well.  We do not lose sight of that. It fuels our passion and drives every decision we make.

Job Posting Title

Mgr Medicare Part D Pharmacy Programs - Remote, Pennsylvania

Job Description

Manages the coordination of benefits in the pharmacy program with Medicare Part D plans. Provides the technical and leadership skills that ensure successful Part D pharmacy operations and program compliance within the pharmacy business unit. Makes business decisions that have impacts on members, providers, Part D plans, CMS, and the company. Requires a working knowledge of Medicare Part D eligibility requirements, Part D plan designs, drug formularies, drug pricing, claims processing and reimbursements, True Out of Pocket expenditures, that ensure successful Part D pharmacy operations compliance within the pharmacy department. Works to ensure established rules, policies, and procedures are implemented so that Medicare Part D operations are successful, efficient, auditable and in compliance with CMS requirements.

Responsibilities

• Ensures the accuracy of payments to Part D sponsors. These payments include but are not limited to premium amounts, late enrollment penalties, and reimbursement of drug claims.
• Ensures the accuracy of payments to Part D sponsors.
• Resolves disputes of payments with the Part D plans on a timely basis.
• Receives, interprets, and acts upon CMS guidance where necessary and applicable.
• Consults with stakeholders to identify and document business needs and objectives, and consults with internal staff to identify and document current operational procedures, and evaluates alternatives applicable to system development activities.
• Provides technical assistance and guidance in identifying, evaluating, and developing systems and procedures, and tracks and documents changes to functional and business specifications.
• Creates or assists others in the writing of user documentation, instructions, and procedures, assists in the creation and execution of acceptance test plans and the associated testing and monitors and documents post-implementation problems and revision requests.
• Assists with writing the annual RFI and evaluating submitted responses from Part D plans.
• Analyzes and interprets data and provides guidance in the plan selection.

Education & Experience

• Education Level
  • A Combination of Education and Work Experience May Be Considered.
  • Bachelors - Business Administration
• Required
  • Yes
  • Yes
• Fields of Study
  • Business Administration

• Experience Level
  • 5+ years
  • 5+ years
• Required
  • Yes
  • Yes
• Details
  • Medicare
  • Operations

Must be eligible to work in the United States without the need for work visa or residency sponsorship.

Additional Qualifications

• At least five years of experience administering a pharmacy benefit for Medicare Part D.
• Familiarity with all facets of the business, including but not limited to enrollment, invoicing, reconciliations, recoupment activities, electronic file submission and retrieval, and customer service.
• Understands the impact coordination of benefits has on other operational areas including member and pharmacy call center customer service.
• Excellent ability to communicate verbally and in writing to varied audiences including Medicare Part D plans, pharmacy providers and members.

Preferred Qualifications

Physical Demands

• Must be able to remain in a stationary position 50% of the time. Must be able to "move or traverse"
• Must be able to constantly operate a computer and/or other office productivity equipment
• Must be able to hear and constantly communicate information and ideas. Must be able to exchange accurate information
• Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

 

Potential pay for this position ranges from $74,000.00 - $118,000.00 based on experience and skills.

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, se