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Posted 591 days ago

Senior Consultant Part D Claims


Responsible for providing subject matter expertise on Medicare Part D in order to effectively support our clients.

Essential Functions:

  • Subject matter expertise in Medicare Part D claims administration including experience in reviewing denied claims for appropriateness.
  • Ability to review, interpret and implement state and federal guidance
  • Perform CMS mock audits in CDAG and FA to confirm compliance with guidance.
  • Monitors the implementation of the corrective action plans and ensures that the result of the action plans are compliant.
  • Mentor and drive work product based on the project
  • Oversee and administer ongoing monitoring program(s) based on guidance
  • Updates policies, procedures and Audit Work Plan based as needed.
  • Adhere to established corporate policies and procedures
  • Perform other duties, as necessary, to meet corporate objectives
  • Travel as required


  • Bachelor’s degree and a minimum of ten (10) years government, health care, pharmacy benefit management, compliance or quality profession (equivalent combination of education and experience considered.)
  • Must have strong Microsoft Office Suite skills. Advanced skills in Word, Excel, Access and PowerPoint required
  • Extensive experience with Medicare Part D formulary administration, accurate claims adjudication and Prescription Drug Event (PDE) processing.
  • Experience with Medicare and/or Medicaid standards required
  • Advanced degree or certification in audit, pharmacy or compliance discipline preferred
  • Must have strong verbal and written communication skills.
  • Individual should be detail oriented with strong organization, prioritization and analytical skills with the ability to work independently.
  • Must work well under tight timelines and adapt quickly to change in a fast-paced, team-oriented, and high-growth environment.