Consultant or Senior Consultant, Part D

Job Summary

Responsible for providing subject matter expertise on Medicare Part D in order to effectively support our clients, as well as, manage the maintenance of our existing suite of products.

Essential Functions

Part D Functions

• Subject matter expertise in Medicare Part D claims administration including experience in reviewing denied claims for appropriateness.
• Ability to review, interpret and implement state and federal guidance
• Perform CMS mock audits in CDAG to confirm compliance with guidance.
• Monitors the implementation of the corrective action plans and ensures that the results of the action plans are compliant.
• Mentor and drive work product based on the project
• Oversee and administer ongoing monitoring program(s) based on guidance
• Updates policies, procedures and Audit Work Plan based as needed.
• Adhere to established corporate policies and procedures
• Perform other duties, as necessary, to meet corporate objectives
• Travel as required

Qualifications

• Bachelor’s degree and a minimum of ten (10) years government, health care, pharmacy benefit management, compliance or quality profession (equivalent combination of education and experience considered.) Pharmacist preferred.
• Must have strong Microsoft Office Suite skills. Advanced skills in Word, Excel, Access and PowerPoint required
• Extensive experience with Medicare Part D formulary administration, accurate claims adjudication and Prescription Drug Event (PDE) processing.
• Experience with Medicare and/or Medicaid standards required
• Advanced degree or certification in audit, pharmacy or compliance discipline preferred
• Must have strong verbal and written communication skills.
• Individual should be detail oriented with strong organization, prioritization and analytical skills with the ability to work independently.
• Must work well under tight timelines and adapt quickly to change in a fast-paced, team-oriented, and high-growth environment.