Account Manager

• Partner closely with and serve as a liaison between the Government Program (GP) Operations and Regulatory business areas to support Account Management teams in addressing clients’ regulatory inquiries and requests.
• Work with internal SMEs to bring forward updates in regulations, internal processes, and industry trends shared by functional areas to support Account Management teams with delivering proactive information to clients.
• Prepare for and support internal and external audits related to CMS, Medicaid, and state-specific requirements.
• Support the coordination of Medicare Part D pre-delegation and delegation audits.
• Support the implementation of state mandates in coordination with Account Management teams and Regulatory business areas.
• Manage and monitor internal tracking systems (i.e., Salesforce, JIRA) related to Compliance, Regulatory and/or GP Operations support.
• Assist Account Management teams in identifying regulatory changes shared by regulated functional areas via internal resources (i.e., PBM Source, Regulatory logs, Slack channels and GP Ops internal meetings).
• Partner with account management teams to provide strategic guidance to clients in regulated industries.
• Review and validate project deliverables for regulatory compliance before client submission.
• Support pre-sales and business development with input on regulatory feasibility and risk (i.e., TDA Prior Authorization components).
• Collaborate with Legal and Compliance teams on Root Cause Analyses (RCAs) and Corrective Action Plans (CAPs).
• Support Operations and Implementation teams with day-to-day client requirements as delegated.
• Support Account Management teams by executing timely and accurate benefit change form requests.
• Analyze incoming client requests and work with internal and external teams to complete required plan documentation.
• Monitor oversight tracker to ensure accurate completion of reviews by CAMs and Account managers for Part D compliance validation.
• Research and respond to claims processing and system configuration inquiries.
• Collaborate cross functionally to support general client operations, as required.
• Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance.

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