The Senior Program Coordinator-PBM Ops is responsible for providing oversight and management of client or corporate sponsored initiatives for the Medicare Part D PBM Oversight organization. This position is also responsible for triaging all incoming requests and workflows, overseeing them to completion and ensuring timeliness requirements and departmental SLAs are achieved. The Senior Program Coordinator serves as an access point and liaison between the client, PBM and other departments within Advantasure.
Annual AEP Project and Quality Management
Management of key project initiatives as prioritized by backlog; development and management of project plans, reporting and RAID (risk, action, issue, decision) logs
Triaging all inbound requests from the client, PBM, and operational areas within Advantasure
Oversight of timeliness requirements supporting departmental SLAs
Maintenance of PBM Operations Initiative Backlog for Leadership review and prioritization
Coordinator for all IT sponsored initiatives
Business Process Improvement initiatives with internal and cross functional teams
Oversight and optimization of data exchanges with trading partners to ensure efficiency and Performance Guarantee compliance: Eligibility, COB, MOOP, Formulary, Claims, Transition Fill, PlanFinder, Long Term Care, Patient Safety, MTM
Project/Initiative Coordinator to support ongoing oversight and improvements with key cross functional teams:
Customer Service - User Provisioning, Override, Enrollment and COB requests and issues
Enrollment -- Member enrollment issues, CVS Enrollment Data Exchange, Prescription Drug Events, FIR and EOB activities
CMS and Advantasure Compliance Communications - oversight of PBM Operations review, attestation and actions
Bachelor's degree in a related field. Relevant combination of education and experience may be considered in lieu of degree. Continuous learning, as defined by the Company's learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged.
Seven to twelve years combined experience as a Project or Program Manager/Coordinator in healthcare or health insurance, Medicare, Medicaid or commercial business lines.
SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
Ability to manage multiple assignments and implement projects.
Demonstrated excellence in a rapid environment, with the ability to gather requirements, communicate product design requirements, and achieve high-quality results within specified timeframes.
Strong knowledge of CMS, and/or ACA regulations.
Understanding of Agile methodologies
Thorough understanding of and ability to demonstrate the Advantasure IT project management lifecycle as well as operational services of Gateway, Billing, and Claims.
Ability to create data flow diagrams and data models, including use case, activity, and workflow diagrams using VISIO.
Ability to convey pertinent information to operational and technical teams.
Strong presentation and analytical/problem-solving skills
Ability to work in both a structured and unstructured environment.
Work is performed in an office setting with no unusual hazards. Minimal travel is required.
The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.
We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.