Sr Program Coordinator PBM Ops

<strong>Working at Advantasure is more than a job &mdash; you&rsquo;re part of a team that is becoming the country&rsquo;s leading healthcare solutions provider.<br /></strong><br /><strong>A career at Advantasure means you&rsquo;ll be part of one of the most dynamic, diversified and innovative healthcare companies in the nation. You&rsquo;ll be helping our clients make their members healthier &mdash; and our communities a better place to call home.</strong>

Lansing, MI


<p class="p1"><strong>At Advantasure, we partner with healthcare clients to simplify their operations and accelerate their business success. Powered by our broad expertise and a comprehensive suite of product and service solutions, we help health plans effectively navigate the complexity of healthcare.</strong></p>

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Competitive Compensation and Benefits Package

Overview: 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.
Responsibilities: <ul> <li>Annual AEP Project and Quality Management</li> <li>Management of key project initiatives as prioritized by backlog; development and management of project plans, reporting, and RAID (risk, action, issue, decision) logs</li> <li>Triaging all inbound requests from the client, PBM, and operational areas within Advantasure</li> <li>Oversight of timeliness requirements supporting departmental SLAs</li> <li>Maintenance of PBM Operations Initiative Backlog for Leadership review and prioritization</li> <li>Coordinator for all IT sponsored initiatives</li> <li>Business Process Improvement initiatives with internal and cross-functional teams</li> <li>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</li> <li>Project/Initiative Coordinator to support ongoing oversight and improvements with key cross-functional teams:</li> <ul> <li>Customer Service - User Provisioning, Override, Enrollment and COB requests and issues</li> <li>Enrollment -- Member enrollment issues, CVS Enrollment Data Exchange, Prescription Drug Events, FIR and EOB activities</li> <li>CMS and Advantasure Compliance Communicati</li> </ul> </ul>
Requirements: <p><strong>EDUCATION:</strong></p> <p>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.</p> <p><strong>EXPERIENCE:</strong></p> <p>Seven to twelve years combined experience as a Project or Program Manager/Coordinator in healthcare or health insurance, Medicare, Medicaid or commercial business lines.</p> <p><strong>SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:</strong></p> <ul> <li>Ability to manage multiple assignments and implement projects.</li> <li>Demonstrated excellence in a rapid environment, with the ability to gather requirements, communicate product design requirements, and achieve high-quality results within specified timeframes.</li> <li>Strong knowledge of CMS, and/or ACA regulations.</li> <li>Understanding of Agile methodologies</li> <li>Thorough understanding of and ability to demonstrate the Advantasure IT project management lifecycle as well as operational services of Gateway, Billing, and Claims.</li> <li>Ability to create data flow diagrams and data models, including use case, activity, and workflow diagrams using VISIO.</li> <li>Ability to convey pertinent information to operational and technical teams.</li> <li>Strong presentation and analytical/problem-solving skills</li> <li>Ability to work in both a structured and unstructured environment.</li> </ul> <p><strong>WORKING CONDITIONS:</strong></p> <p>Work is performed in an office setting with no unusual hazards. Minimal travel is required.</p>