Medicare Part D Advisor
Job DescriptionProvides 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
TitleMedicare Part D Advisor
Job FamilyPharmacy Group
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date11/27/2019
Date Requisition Created11/27/2019
Work ExperienceMedicare Part D (MedD), Project/Program Management
EducationA Combination of Education and Work Experience May Be Considered. (Required), Bachelors (Required)
License and Certifications - Required
License and Certifications - Preferred
Other Job Requirements
- 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.
Top 5 reasons to work at Magellan
Meaningful Work With People Who Care
At Magellan Health you can do meaningful work and feel confident that you matter in an organization that makes a real difference in the world - one that cares deeply and uses its employees’ collective insight as a competitive advantage.Read More
We are Compassionately Curious
Magellan Health is a place where we listen with real empathy. It’s one of our biggest strengths. It helps us to support each other and develop innovative solutions for the fastest growing, most complex areas of healthcare.Read More
We are Better Together
We rely on our innate ability to work as a high-functioning collaborative team to facilitate compassionate care to all of our members. With such interdependency comes trust, challenge and innovation.Read More
We believe work and life should flow together in unison. We offer resources that match your professional development, a culture that welcomes your ideas, and unparalleled flexibility to fit work around your life.Read More
Be your best at Magellan Health. We’re a collective of remarkably motivated and driven professionals. As a team, we’re proud of the high standards we set for each other and we’re continually inspired to do our best work.Read More
When you sayLife @ Magellan
To be the best you have to work with the bestWe hear you