Manager of Medicare Part D and EGWP Programs - East Syracuse, United States - ProAct Inc

Description

Join Our Team as a Medicare Part D/EGWP Programs Specialist at KPH Healthcare Services, Inc.

We are looking for a candidate with extensive experience in Medicare Part D and/or EGWP programs to join our team!

Scope of Responsibilities: As a Medicare Part D/EGWP Programs Specialist, you will oversee and manage the operational aspects of these programs to ensure compliance and quality control.

Job Overview: In this role, you will be the go-to expert for the administration of EGWP programs through ProAct. Your responsibilities will include managing benefit designs, formularies, claims and payment processing, reconciliation, and ensuring compliance with Medicare Part D standards.

Responsibilities

• Provide oversight of Medicare Part D/EGWP programs
• Ensure compliance with CMS rules and regulations
• Support vendor relationships and implementation of EGWP pharmacy programs
• Act as the main contact for Plan Sponsor contracts
• Coordinate with internal teams for accurate benefit build and claims processing
• Resolve any inquiries or escalations promptly
• Maintain compliance with regulations and identify potential risks
• Review and implement policy changes as needed
• Collaborate with internal and external teams for program enhancements
• Assist in creating client materials in compliance with regulations

Qualifications

Required Job Skills:

• Excellent communication skills
• Effective presentation abilities
• Strong problem-solving and analytical skills
• Organizational and strategic thinking capabilities
• Self-motivated and able to prioritize tasks
• Proficiency in Microsoft Office and Adobe
• Knowledge of PBM and/or TPA industry preferred

Education

• Minimum: High School Diploma or GED
• Preferred: BS Degree in Business or related field

Experience:

• 5+ years experience in Medicare Part D and/or EGWP programs

Special Employment Conditions:

• Drug test required
• Exclusion and sanction monitoring
• Additional eligibility requirements may apply

Compensation:

$60,000 per year.

The final offer will be based on relevant skills, experience, and education. Join us at KPH Healthcare Services, Inc., a company that complies with all regulations for fair compensation!