Pharmacy Payment Policy Lead

Pharmacy Payment Policy Lead, Remote

• Full-time
• 100% Remote 
• Must be eligible to work in the US without requiring sponsorship.  
  
• NO THIRD PARTY RECRUITERS PLEASE!  CANDIDATES MUST BE SELF-REPRESENTED.

Description

Experienced leader with expertise in Medicare payment policy and operations, pharmacy services, and health plan audits/compliance. 

Responsibilities

• Lead and grow a diverse team with the responsibility to perform advanced analyses and studies of Medicare Part D claims and administrative data. 
• Advise clients in their efforts to identify and assess improper payments in the Medicare program, by providing pharmacy and Medicare Part D subject matter expertise. 
• Leverage client specific knowledge and network to lead, plan, and manage progressively larger and more complex programs. 
• Provide program oversight contributing to project expansion, managing measurement approaches, and synergizing related programs.

Requirements

Basic Qualifications:

• 10+ years of experience in a managerial role overseeing projects and diverse teams of technical experts
• 10+ years of experience specific to Medicare Part D payment policy and operations and error measurement
• Experience with health plan audit/compliance programs
• Working knowledge of Medicare Advantage encounter data or Prescription Drug Event (PDE) data
• Ability to obtain and maintain a Public Trust or Suitability/Fitness determination based on client requirements
• Certified Pharmacy Technician (CPhT) or degree in a related field; 10+ years of experience in a relevant professional work environment in lieu of a degree

Additional Qualifications:

• Experience with delivering technical assistance to a wide range of stakeholders and using a variety of delivery techniques
• Experience in facilitating large meetings with both internal and external audiences
• Experience with the federal procurement and proposal process
• Demonstration of existing relationships, as well as the ability to build new key relationships with programmatic/agency leaders in the Centers for Medicare and Medicaid Services
• Experience with Medicare claims and/or pharmacy claims (e.g.,1500 claim forms, Part D NCPDP claims, UB-04, NCPDP claims, etc.)
• Basic knowledge of statistical principles
• Basic knowledge of analytic scripting, programming languages, and packages
• PharmD or Ph.D. in Pharmacy or related field

Please Note:

• Only those individuals selected for an interview will be contacted.
• No calls, inquiries, or Third-Party Vendors please.
• We are an equal opportunity employer. We encourage applications from candidates of all backgrounds and experiences. (The ACI Group is unable to sponsor H1B Visas).
• $1000 Referral Bonus - www.aci.com.

Since 1988, The ACI Group, a Baltimore-based staffing firm, has been committed to hiring the industry's leading professionals, and presenting exciting career opportunities. We have access to varied types of contract, permanent and contract-to-perm positions and offer a choice of employment options including a full benefits package.