Full-time Pharmacist responsible for providing subject matter expertise on Medicare Part D to support MA-PD plan
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 and FA to confirm compliance with guidance.
- Oversee and administer ongoing monitoring program(s) based on guidance
- Updates policies, procedures as needed.
- Adhere to established corporate policies and procedures
- Perform other duties, as necessary, to meet corporate objectives
- Licensed Pharmacist and a minimum of ten (10) years government, health care, pharmacy benefit management, compliance or quality profession (equivalent combination of education and experience considered.)
- 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.
- Located in San Diego, CA