What are the responsibilities and job description for the Government Pharmacy Programs position at AscellaHealth?
Government Pharmacy Programs (Medicare) Manager
What we are looking for is 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.
About the Role
- 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.
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.
- Excellent 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
About Us
We are 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.
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.
