Vendor Relations Analyst - Medicare D at Tempe

Job Description

Position Purpose:

Coordinate activities related to vendor monitoring and oversight with an emphasis on compliance, claims adjudication and review

Position Responsibilities:

Serve as a liaison with delegated vendors to ensure timely and accurate processing for Medicare Part D business
Review, track and report paid claims to ensure compliance with CMS and Medicare Part D regulations
Research claims history within vendor management systems by monitoring adjudication errors and potential compliance risks
Ensure vendor impact analysis is completed to resolve all claims audit findings
Assist with internal review and follow-up for CMS audit questions with regards to paid claims adjudication, copay logic, and Formulary administration
Create performance metrics to ensure vendor and contractual requirements are met
Ensure timely receipt of accurate and complete reporting from the delegated vendors

Job Requirements

Knowledge/Experience:

Bachelors degree in Business or Health administration, related field or equivalent experience. 3+ years of benefits administration (i.e. configuration, claims reviews, set up, or implementation) experience, preferably in the Medicare, Medicaid, healthcare or pharmacy benefit management industry. Knowledge of CMS Medicare Part D requirements preferred.

Licenses/Certifications: Current states technician license or Certified Pharmacy Technician (CPhT) certification preferred.

Country: USA, State: Arizona, City: Tempe, Company: US Script.