Job Description
Job description
Location: Remote (For Non-Local) or Hybrid (Local to NYC area)
Position Summary:
The Government Programs Operations Analyst will be responsible for the day-to-day operational tasks related to Medicare Part D processes, including, but not limited to analyzing PDE errors, claims monitoring, and reversing and reprocessing of claims.
Position Responsibilities:
Responsible for the day-to-day operational tasks related to Medicare Part D processes, including PDE and Medicare Plan Finder.
Manage error handling and change management for PDE/Encounters, plan finder, etc. assuring adherence to client and CMS requirements
Identify and work cross functionally to resolve any operational errors or issues including root cause analysis and the development and implementation of necessary corrective actions
Responsible for daily claims monitoring to ensure claims are paying/rejecting as appropriate
Manage claims correction for retro-eligibility changes and COB
Assist team members with development and testing of operational processes and project deliverables
Assist with development of best practices regarding government programs operational projects
Leverage deep understanding of Medicare & Medicaid LOB’s, regulatory environment to support product strategy and service delivery
Maintain current knowledge of Medicare & Medicaid requirements to facilitate compliance of ongoing business operations
Required Qualifications:
3+ years of relevant PBM and/or Health Plan experience supporting Medicare Part D
2+ years of experience with PDE process management, analysis and resolution
Thorough knowledge Medicare regulatory requirements and associated product and/or operational workflows
MS Excel Skills – ability to create/maintain pivot table, forms, and formula’s (i.e. vlookup, true, if, left, etc)
Ability to balance multiple complex projects simultaneously
Extremely flexible, highly organized, and able to shift priorities easily
Attention to detail & commitment to delivering high quality work product
Base Salary: $70,000 - $80,000
Visa Sponsorship: Capital Rx does not provide sponsorship to any candidates. This includes, but is not limited to those that require H1-B, TN, OPT, etc. Candidates must have authorization to work in the US at the time of application and throughout employment.
Nothing in this position description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.
About Capital Rx
Capital Rx is a full-service pharmacy benefit manager (PBM) and pharmacy benefit administrator (PBA), advancing our nation’s electronic healthcare infrastructure to improve drug price visibility and patient outcomes. As a Certified B Corp™, Capital Rx is executing its mission through the deployment of JUDI®, the company’s cloud-native enterprise health platform, and a Single-Ledger Model™, which increases visibility and reduces variability in drug prices. JUDI connects every aspect of the pharmacy ecosystem in one efficient, scalable platform, servicing millions of members for Medicare, Medicaid, and commercial plans. Together with its clients, Capital Rx is reimagining the administration of pharmacy benefits and rebuilding trust in healthcare.
Capital Rx values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, ****** orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
#LI-SE1
Location: Remote (For Non-Local) or Hybrid (Local to NYC area)
Position Summary:
The Government Programs Operations Analyst will be responsible for the day-to-day operational tasks related to Medicare Part D processes, including, but not limited to analyzing PDE errors, claims monitoring, and reversing and reprocessing of claims.
Position Responsibilities:
Responsible for the day-to-day operational tasks related to Medicare Part D processes, including PDE and Medicare Plan Finder.
Manage error handling and change management for PDE/Encounters, plan finder, etc. assuring adherence to client and CMS requirements
Identify and work cross functionally to resolve any operational errors or issues including root cause analysis and the development and implementation of necessary corrective actions
Responsible for daily claims monitoring to ensure claims are paying/rejecting as appropriate
Manage claims correction for retro-eligibility changes and COB
Assist team members with development and testing of operational processes and project deliverables
Assist with development of best practices regarding government programs operational projects
Leverage deep understanding of Medicare & Medicaid LOB’s, regulatory environment to support product strategy and service delivery
Maintain current knowledge of Medicare & Medicaid requirements to facilitate compliance of ongoing business operations
Required Qualifications:
3+ years of relevant PBM and/or Health Plan experience supporting Medicare Part D
2+ years of experience with PDE process management, analysis and resolution
Thorough knowledge Medicare regulatory requirements and associated product and/or operational workflows
MS Excel Skills – ability to create/maintain pivot table, forms, and formula’s (i.e. vlookup, true, if, left, etc)
Ability to balance multiple complex projects simultaneously
Extremely flexible, highly organized, and able to shift priorities easily
Attention to detail & commitment to delivering high quality work product
Base Salary: $70,000 - $80,000
Visa Sponsorship: Capital Rx does not provide sponsorship to any candidates. This includes, but is not limited to those that require H1-B, TN, OPT, etc. Candidates must have authorization to work in the US at the time of application and throughout employment.
Nothing in this position description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.
About Capital Rx
Capital Rx is a full-service pharmacy benefit manager (PBM) and pharmacy benefit administrator (PBA), advancing our nation’s electronic healthcare infrastructure to improve drug price visibility and patient outcomes. As a Certified B Corp™, Capital Rx is executing its mission through the deployment of JUDI®, the company’s cloud-native enterprise health platform, and a Single-Ledger Model™, which increases visibility and reduces variability in drug prices. JUDI connects every aspect of the pharmacy ecosystem in one efficient, scalable platform, servicing millions of members for Medicare, Medicaid, and commercial plans. Together with its clients, Capital Rx is reimagining the administration of pharmacy benefits and rebuilding trust in healthcare.
Capital Rx values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, ****** orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
#LI-SE1
💡 Quick Summary
Seeking a career-building opportunity? The Government Programs Operations Analyst (PDE) position is now open for candidates interested in the Government Job Alert sector. This role in Adams offers a professional environment and growth potential.
Requirement Snapshot: Candidates should possess basic communication skills, a proactive attitude, and the ability to work in a team. Experience in Government Job Alert is a plus.
