Ensure regulatory compliance with respect to prescription benefits set up and year-round CMS Program Audit, 1/3 Financial audit, National MEDIC, and other audits readiness;
Provide leadership and support during all CMS Regulatory Audits related to pharmacy operations;
Ensure accuracy of written responses and/or documentation for the pharmacy audits;
Prepare written responses or documentation for pharmacy audits.
Serve as a subject matter expert for Part D Reporting requirements.
Maintain current knowledge of Medicare Part D regulations by participating in CMS calls and reading released guidance.
Oversee the accurate implementation and maintenance of pharmacy benefits.
Lead automation efforts related to the Prescription Drug Event, Benefits Configuration and Testing Initiatives.
Prepare documentation for Service Area Expansion application submission to CMS.
Collaborate with other SCAN departments by participating in cross-functional meetings.

Requirements

Five (5) years or more of Medicare Part D experience with a health plan or PBM required.
Three (3) years of leadership experience in a managed care setting with full scope of supervision for non-licensed staff.
Three (3) years or more of experience in data analysis required.
Bachelor's Degree or equivalent experience - Business/Healthcare.
Active Pharmacy Technician License preferred.
Expert in Medicare Part D.
Knowledge of CMS Part D regulations e.g., CMS Call Letters, MAPD application, Claims Processing, Part D Reports.
Technologically savvy and able to utilize information systems effectively (MS Office - Word, Excel, PowerPoint, Access, Visio, Outlook; SQL).

Benefits

An annual employee bonus program
Robust Wellness Program
Generous paid-time-off (PTO)
11 paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday
Excellent 401(k) Retirement Saving Plan with employer match and contribution
Robust employee recognition program
Tuition reimbursement

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

Medicare Part D experiencedata analysispharmacy benefits implementationautomationdocumentation preparationaudit readinessfinancial auditsubject matter expertbenefits configurationtesting initiatives

Soft Skills

leadershipcollaborationcommunicationorganizational skills

Certifications

Pharmacy Technician LicenseBachelor's Degree