Medicare Part D Advisor

Arizona, Utah

Job Description

Provides a consultative approach to our clients' implementations, enhancements and reporting needs. The group supports internal and external clients in their Medicare Part D responsibilities, by striving to meet and exceed overall client satisfaction through identifying value-added services and solutions across Medicare Part D segment. Collaborates with peers in all Medicare Part D supporting segments, including but not limited to Prescription Drug Plan (PDP), Employer Group Waiver Plans (EGWP), Retiree Drug Subsidy (RDS) and Medicare Advantage Part D (MAPD). Serves as the point of contact and subject matter expert during implementation and on-going client support of enhancement projects.
Partners with internal teams to support the ideation and development of enhanced or new programs and services to strengthen the framework of the various lines of Medicare Services.
  • Ensures accurate and systematic reporting within a given SLA by applying understanding of the Centers for Medicare and Medicaid Services (CMS) Medicare Part D guidance, systems and processes.
  • Works in concert with the sales and account services teams to proactively provide client support on Medicare Part D implementations and initiatives (e.g., new client on-boarding, Star plan ratings and CMS audit support). 
  • Partners/engages with various decision makers in the organization to help facilitate business decision and approval.
  • Analyzes, understands and works/triages incoming data and reporting requests.
  • Provides support to Business Analysts and IT teams in defining projects and Business Requirements Documentation (BRDs).
  • Leads internal teams on reporting issue resolution and root cause analysis in support of contractual commitments, Business Impact Analysis (BIA) and Corrective Action Plans (CAPs).
  • Partners/engages with internal and external stakeholders to understand data/reporting concerns and build tactical solutions and drive long term fixes.
  • Works with reporting analyst and programming staff to ensure accuracy of code development for CMS reporting.
  • Uses expertise in Medicare Part D to identify improvement opportunities and work cross functionally to drive process enhancements in order to deliver best in class service to our Plans.
  • Other duties as required. 

General Job Information

Title

Medicare Part D Advisor

Grade

25

Job Family

Pharmacy Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

11/27/2019

Date Requisition Created

11/27/2019

Work Experience

Medicare Part D (MedD), Project/Program Management

Education

A Combination of Education and Work Experience May Be Considered. (Required), Bachelors (Required)

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements

Responsibilities

  • Bachelor's degree plus 5 years of related work experience required.
  • May consider 10+ years of industry and work-related experience in lieu of degree.
  • Thorough understanding of the operational framework and compliance requirements of the Medicare Part D business. 
  • 5+ years of experience with Medicare Part D. 
  • 5+ years of strong functional capabilities using Microsoft applications. 
  • 3+ years of project management skills with the ability to manage multiple tasks simultaneously. 
  • Ability to manage conflict resolution to ensure successful outcomes. 
  • 3+ years of experience with SQL or SAS reporting.
  • 3+ years of experience in understanding and communicating (both written and verbally) complex business and industry issues to all levels of business (internal and client facing).
  • Solid understanding of Part D claims adjudication logic, Financial Information Reporting (FIR), payment transaction information (Nx transactions), True out-of-pocket (TrOOP) accumulators, Prescription Drug Event (PDE) calculations;, Low Income Subsidy (LICS), direct and indirect remuneration (DIR), Explanation of Benefits (EOB), Recovery Audit Contractor (RAC) [hospice, End-Stage Renal Disease (ESRD) and unauthorized/deceased/sanctioned prescriber], calculations of sales tax.
  • Ability to work under tight deadlines and meet deliverables.
  • Excellent verbal and written communication skills. 

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

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