Medicare Part D and EGWP Programs Manager

2 weeks ago


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

The selected candidate will oversee the operational activities of Medicare Part D and EGWP programs, ensuring compliance with CMS rules and regulations. This role requires a strong understanding of benefit designs, system management, and vendor relationships.

Key Responsibilities
  • Provide oversight of operational activities of Medicare Part D/EGWP programs
  • Ensure compliance with CMS rules and regulations surrounding Medicare Part D
  • 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
  • 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.
Requirements
  • 5+ years experience in Medicare Part D and/or EGWP programs
  • 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
Compensation

$60,000 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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