Job Description

CDPHP and its family of companies are mission-driven organizations that support the health and well-being of our customers and the communities we are proud to serve.
CDPHP was founded in Albany in 1984 as a physician-guided not-for-profit, and currently offers health plans in 29 counties in New York state. The company values integrity, diversity, and innovation, and its corporate culture supports those values wholeheartedly. At CDPHP, the employees have a voice and are encouraged to make an impact at both the company and community levels through engagement and volunteer opportunities. CDPHP invests in employees who share these values and invites you to be a part of that experience.

The Pharmacy Enterprise Medicare Advisor is the pharmacy subject matter expert in Medicare benefits and formulary design. The Advisor will be responsible for supporting internal partners in configuration, formulary, and audit. They will ensure operational and IT business activities are aligned with department strategies. The Advisor will be responsible for the testing of pharmacy benefits, formulary, and claims surveillance activities. The Advisor will lead the annual Medicare implementation with PBM and real-time/mock third party vendors. Although CDPHP and it's subsidiaries are located in Albany NY; remote candidates are encouraged to apply!

QUALIFICATIONS:

Bachelor’s degree required. Four years relevant experience may be substituted for degree.
Minimum five (5) years of pharmacy experience pertaining to Medicare Managed Care; with a focus on benefits, compliance or member service required.
Experience with pharmacy claims processing, PBM systems, pharmacy billing and payment required.
Experience with CMS audits preferred.
Experience working with Medicare Part D regulations and operational monitoring activities to effectively perform duties that support Medicare plans and compliance with CMS requirements required.
Experience with data analysis and reporting required.
Experience with Microsoft Office, including Word, Excel, Outlook and PowerPoint is required.

Demonstrated ability to analyze Federal and State statutes and regulations for operational implementation.
Demonstrated ability to pro-actively identify problems, as well as recommend and/or implement effective solutions.
Must be detail-oriented with strong organizational skills, including the ability to multi-task and coordinate workflow.
Demonstrated ability to work collaboratively with multiple partners to positively affect outcomes at the team, organization and member level.
Demonstrated ability to provide excellent customer service and develop relationships both internally and externally.
Excellent verbal and written communication skills.
Flexibility to adapt to a changing and fast-paced environment.
Demonstrated ability to work with and maintain confidential information.

As an Equal Opportunity / Affirmative Action Employer, CDPHP will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, protected veterans status, or any other characteristics protected under applicable law. To that end, all qualified applicants will receive consideration for employment without regard to any such protected status.

CDPHP and its family of companies include subsidiaries Acuitas Health LLC, Strategic Solutions Management Consultants (SSMC), Practice Support Solutions (PSS), and ConnectRX Services, LLC.

This job was posted on Sat Apr 17 2021 and expired on Tue Apr 20 2021.

Minimum $42K /yr

$81K /yr Average

Maximum $187K /yr

Tasks

Greet customers and help them locate merchandise.

Accept prescriptions for filling, gathering and processing necessary information.

Operate cash register to process cash or credit sales.

Answer telephone inquiries, referring callers to pharmacist when necessary.

Receive, store, and inventory pharmaceutical supplies or medications, check for out-dated medications, and notify pharmacist when inventory levels are low.

Unpack, sort, count, and label incoming merchandise, including items requiring special handling or refrigeration.

Restock storage areas, replenishing items on shelves.

Maintain and clean equipment, work areas, or shelves.

Prepare prescription labels by typing or operating a computer and printer.

Compound, package, and label pharmaceutical products, under direction of pharmacist.

Provide customers with information about the uses, effects, or interactions of drugs.

Process medical insurance claims, posting bill amounts and calculating copayments.

Calculate anticipated drug usage for a prescribed period.

Perform clerical tasks, such as filing, compiling and maintaining prescription records, or composing letters.

Prepare, maintain, and record records of inventories, receipts, purchases, or deliveries, using a variety of computer screen formats.

Deliver medication to treatment areas, living units, residences, or clinics, using various means of transportation.

Operate capsule or tablet counting machine that automatically distributes a certain number of capsules or tablets into smaller containers.

Skills

Reading Comprehension - Understanding written sentences and paragraphs in work related documents.

Active Listening - Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.

Speaking - Talking to others to convey information effectively.

Social Perceptiveness - Being aware of others' reactions and understanding why they react as they do.

Service Orientation - Actively looking for ways to help people.

Knowledge

Clerical - Knowledge of administrative and clerical procedures and systems such as word processing, managing files and records, stenography and transcription, designing forms, and other office procedures and terminology.

Sales and Marketing - Knowledge of principles and methods for showing, promoting, and selling products or services. This includes marketing strategy and tactics, product demonstration, sales techniques, and sales control systems.

Customer and Personal Service - Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.

English Language - Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.