Medicare Part D and EGWP Programs Manager

2 weeks ago


East Syracuse, New York, United States KPH Healthcare Services Full time
Job Summary

We are seeking a highly skilled and experienced professional to join our team as a Medicare Part D and EGWP Programs Manager at KPH Healthcare Services, Inc. This is a challenging and rewarding role that requires a strong understanding of Medicare Part D and EGWP programs, as well as excellent communication and problem-solving skills.

Responsibilities
  • Provide oversight and management of Medicare Part D and EGWP programs, ensuring compliance with CMS rules and regulations.
  • Support vendor relationships, daily operations, and implementation of EGWP pharmacy programs.
  • Understand service agreements and terms between ProAct and vendor partners, and clients.
  • Act as primary point of contact for Plan Sponsor contracted to administer programs.
  • Understand benefit build, eligibility, enrollment, formulary, claims processing, clinical, files management, reporting, and other components of EGWP programs.
  • Coordinate with implementation teams to ensure accurate benefit build and claims processing.
  • Responsible for supporting inquiry/issue/escalation resolution.
  • Oversee resolution of prescription drug event (PDE), eligibility, or other issues that are necessary for EGWP programs.
  • Maintain understanding and compliance with current on rules and regulations pertaining to Medicare Part D/EGWP programs.
  • Evaluate potential impact and applicability of new or changed rules and/or regulations.
  • Identify performance and compliance risks and communicates to leadership and/or others in a timely manner to minimize non-compliance.
  • Review new guidance, memos, and regulations and create and adjust internal policies, processes, and/or procedures appropriately. Communicate changes to leadership and/or others as required.
  • Supports collaborative relationships with internal and external teams or partners to determine best practices, efficiencies, or process improvements that enhance program performance and member experience.
  • Partner with other departments or business units to grow, develop, and enhance EGWP programs and opportunities.
  • Assist in creation of member and client materials ensuring consistent with CMS regulations.
  • Support client service teams with presenting analytics or other reports to clients and/or business partners.
Qualifications
  • Excellent oral and written communication skills.
  • Ability to create and conduct effective presentations.
  • Problem solving and analytical skills.
  • Strategic and creative thinker.
  • Strong organizational skills.
  • Self-motivated with ability to prioritize multiple tasks along with a strong sense of urgency and responsiveness.
  • Proficient in Microsoft Office and Adobe.
  • Understanding of PBM and/or TPA industry, preferred.
Education
  • Minimum: High School Diploma (or currently enrolled) or GED.
  • Preferred: BS Degree in Business or similar.
Experience
  • 5+ years experience in Medicare Part D and/or EGWP programs.
Special Conditions of Employment
  • Drug test.
  • Initial and continuous exclusion and sanction/disciplinary monitoring.
  • Any and all additional eligibility requirements based on the specific position.
Compensation

$60,000 - $80,000 per year. The final offer will be determined after careful consideration of multiple factors such as relevant skills, years of experience, and education.

KPH Healthcare Services, Inc. is a multistate organization and abides by all local, state, and federal regulations as it pertains to minimum wage requirements.



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