Manager, Medicare D Eligibility - Pharmacy Benefits Management

Health Care/Business Office

Manager, Medicare D Eligibility
Pharmacy Benefits Management

Prime Therapeutics LLC is a pharmacy benefits solutions company dedicated to providing innovative, clinically-based, cost-effective pharmacy solutions for clients and members.

We are seeking a professional with strong leadership skills to manage a team of Eligibility and COB staff members, including eligibility administration, manual eligibility, eligibility reconciliation, claims reprocessing, member adjustments, PDE reconciliation, COB processing, and new client implementations. This individual will be responsible for managing the workload, overseeing the workflow, work product, special projects and programs, and providing direction to the Eligibility Staff and COB staff.

Specific accountabilities:

Manage and monitor the workflow of incoming eligibility files and records for Medicare D clients and provide weekly report to Director with assignment and productivity breakdown and analysis.
Responsible for creating and maintaining reference manuals, standard operating procedures, workflow documents and performance metrics.
Responsible for providing and tracking the team performance metrics, quality, and workload volume to management, including the review the work of the team members to check for accuracy and needed changes/corrections. Communicate and document recommended changes.
Responsible for resolving escalated eligibility processing or operational issues from various internal areas, vendors, and clients to provide prompt resolution to client satisfaction. Duties include the oversight of Prime?s internal escalation database and documenting inquiries, issues, errors and their resolution.
Manage project timelines and action plans. Balance resource needs and priorities. Ensure representatives are working projects to conclusion in a timely, efficient, and accurate fashion. Take the lead on projects and ensure that tasks are completed per the guidelines, requirements, and necessary timeline.
Provide project status reports to Manager/Director.
Implement new Medicare D client and business through identification of data mapping and file layout design, as well, as develop specific client and product eligibility administration procedures.
Provide and oversee manual eligibility input for all clients, including member and group adds, retro-eligibilty changes, enrollment reconciliation, low income subsidity changes, adjustments, HIPAA alternative address data, etc. Manage member manual adjustments and the reprocessing of claims based on retro-eligibility changes. Oversee the review and resolution of PDE submission errors.
Provide and oversee the regular and ongoing reconciliation process between Prime and its enrollment and eligibility vendors. Provide regular reports and manage action plans when data is out of synch.
Oversee and manage the coordination of benefits team with regard to the handling and resolving of escalated coordination of benefits issues.
Ensure that a representative from Eligibility is attending all relevant Client team meetings and project meetings and that relevant information is documented, shared, and addressed.

Qualifications:

Bachelor?s degree or equivalent work experience, with 3-5 years health care and/or eligibility process experience.
3-5 years of management experience.
Medicare and/or government program experience preferred
Strong technical knowledge of Eligibility and ability to apply knowledge to all aspects of company initiatives.
Exceptional organizational skills and the ability to manage multiple, complex projects simultaneously without compromising quality.
Strong leadership and mentoring skills
Effective oral and written communication skills

At Prime, you will enjoy a supportive environment and plenty of advancement opportunity within a fast-growing business. You will also be rewarded with a competitive salary and benefits package.

For confidential consideration, please apply online at:
www.primetherapeutics.com/aboutrecruitment.htm

Prime Therapeutics LLC
1305 Corporate Center Drive
St. Paul, MN 55121

Equal Opportunity Employer