Government Pharmacy Programs (Medicare) Manager

What we are looking for

We seek a dedicated and passionate Government Programs Manager to oversee the day-to-day Medicare Part D support for AscellaHealth clients and internal team members. They will conduct end-to-end testing and review of accurate claim processing according to CMS guidelines and Plan Benefit Design. This person will perform quality inspections and audits, assist with problem-solving of client and program issues, and conduct necessary training. The Government Programs Manager will support efforts to design, develop, implement, and oversee various Medicare Part D processes that support both regulatory requirements and client expectations to ensure that AscellaHealth remains compliant with Centers for Medicare and Medicaid Services (CMS) guidance of our All-Inclusive Care for the Elderly (PACE) lines of business and other Medicare Part D programs.

This position will be an individual contributor with no direct reports and is expected to be a hybrid role in our Berwyn, PA office with 3 days in-office.

What the position will be doing

• Analyze daily program reporting and claim processor adjudication data to ensure program oversight and compliance with CMS guidance.

• Audit support, including client audits and/or CMS audits

• Create accurate and timely internal and client reporting.

• Serve as a subject matter expert for the business processes related to quality management and improvement.

• Develop and maintain pre-implementation and post-implementation claim test scenarios.

• Assist with providing Client and vendor support.

• Strong understanding of pharmacy claims adjudication system(s).

• Manage implementation project plans for new Medicare clients.

• Produce and maintain business process documentation, such as policies and procedures, job aides, and work instructions.

• Support and assist in resolving identified operational errors, including root cause analysis and developing and implementing necessary actions.

• Help maintain trusting relationships with internal and external stakeholders through service delivery excellence.

• Perform other related duties as assigned or as necessary; remain flexible and adaptable in work schedules and work assignments as defined by departmental and organizational needs.

  Necessary Skills, Education & Abilities

• High School degree, or equivalent, required. Additional education such as college or university, preferred.

• Three (3) years of experience in a quality assurance, audit, or program management role preferred. Certified Pharmacy Technician  (CPhT) or equivalent experience in managing pharmacy benefit programs or Medicare Part D programs and clients.

• Medicare or government programs experience in a PBM, Health Plan, or third-party payer setting preferred

• Project management experience, formulary management experience preferred

• Understanding of NCPDP standards and applications

• Experience with third-party drug database classification hierarchies and coding

• The ability to thrive in a fast-paced environment with constantly changing priorities.

• E xcellent analytical skills and the ability to provide solutions to complex problems

• Ability to be highly transparent, ethical, and driven.

• Relentless attention to detail and the ability to be a creative self-starter and team player.

• Excellent written and verbal communication skills and interpersonal skills required

• Ability to communicate with all organizational levels and clients, customers, and vendors.

• Ability to think and act independently, formulate, and support new ideas, champion new initiatives within and beyond the scope of own responsibilities.

• Ability to provide direction and motivation and set an example through open communication and modeling best practices.

• Proficient in Microsoft Office Suite, specifically Excel, Word, PowerPoint, and Outlook

  Our Story

  AscellaHealth is a global partner that delivers proven end-to-end solutions to both life sciences and healthcare companies to enhance the quality of life for patients with complex, chronic conditions. Every day, our team gets critical healthcare products from manufacturers to patients while ensuring an efficient flow of funds between payers and pharma. 

  Our Mission:

  To shape the future of healthcare by delivering end-to-end solutions throughout the global specialty pharmaceutical industry that optimize outcomes, enable cost savings, and accelerate patient access to life-changing therapies.

  Our Vision:

  We aim to be a leader in global health innovation, ensuring that complex therapies reach patients through an ecosystem of solutions that remove barriers and improve health outcomes.

  Visit www.AscellaHealth.com.

  Our Culture:

  The AscellaHealth culture is one of diversity and inclusion with a patient-centric approach in everything we do. Our highly innovative and collaborative environment ensures we deliver best-in-class specialty pharmacy solutions addressing the unmet needs in the market.

  The AscellaHealth provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

AscellaHealth provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

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