<p>PURPOSE OF POSITION:</p> <p>The primary purpose of the Medicare Part D Representative is to perform ongoing coordination and resolving of service issues, claims processing, coverage determinations and analysis of the pharmacy benefit plans for all Primetime Health Plan clients. The Medicare Part D Representative will be cross-trained to handle issues regarding the use and maintenance of the Part D pharmacy benefit. This position must consistently relay the positive aspects of PTHP to every caller, internally and externally. The representative is responsible for accurately, courteously, and promptly transacting any and all requests in a highly professional manner in compliance with CMS and NCQA standards at all times.</p> <p>This position requires a hands-on approach to the review, analysis, and comprehension of current and new requirements as published by CMS. The Part D Representative is responsible for meeting or exceeding turnaround time standards and quality expectations of Medicare Part D as put forth by CMS. The person must work effectively cross- functionally to address internal and client/beneficiary inquires/issues. Ability to understand process flows. The Medicare Part D Representative will assist the Medicare Part D team in projects that are assigned on an ad-hoc basis.</p> <p>RESPONSIBILITIES & EXPECTATIONS:</p> <ul> <li>Accurately report and document pertinent information. </li><li>Use good judgment in referring inquires to other peers, supervisor, and Pharmacy Director. </li><li>Consistently demonstrate ability to multi-task and prioritize work in accordance with organizational position and necessity. </li><li>Accurately check eligibility of member and obtain information when necessary. </li><li>Interpret and apply plan language correctly. </li><li>Conform to any legal mandates related to the plan, such as, but not limited to: appeal rights and the external review process. </li><li>Adhere to notification guidelines related to healthcare requests </li><li>Accurately track turnaround times for designated tasks. </li><li>Maintain accurate and complete documentation in electronic data systems. </li><li>Anticipate and follow through with both internal and external customer requests to their satisfaction. Seek assistance of others and other departments when needed. </li><li>Participate in orientation of new personnel as requested and across product lines if necessary. </li><li>Handle difficult and sensitive issues with tact, exercise judgment where necessary and consult supervisor on major problems and issues. </li><li>Demonstrate initiative in problem-solving. </li><li>Collaborate and cooperate with co-workers, supervisors and those in authority positions creating a productive working relationship throughout the organization. </li><li>Perform all duties in an independent manner with little or no direct supervision. </li><li>Actively seeks and pursues opportunities to make a contribution and demonstrates desire for learning. </li><li>Assume personal responsibility for on-going continuing education and/or professional development. </li><li>Act in AultCare's and Prime Time Health Plan's best interest when dealing with non-participating providers in situations such as negotiations, contracts and verbal agreements. </li><li>Maintain confidentiality of member and employer information at all times. </li><li>Process Improvement: Continuously reviews, recommends and implements improvement steps, as needed or directed. </li><li>Seeks supervisory guidance/approval as appropriate. </li><li>Portrays professional image: follows dress code, communicates with internal and external customers in a professional manner, including appropriate verbal and written grammar. </li><li>Promotes and demonstrates professional standards to enhance the development of the department. </li><li>Practices ethical conduct. </li><li>Meets acceptable attendance and punctuality expectations (excluding FMLA) </li></ul> <p>The above statements reflect the general duties considered necessary to describe the principle functions of the job as identified, and are not a detailed description of all the work requirements that may be inherent to this position.</p> <p>All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, age, national origin, disability, or protected veteran status. AultCare is an EEO/AA Employer M/F/Disability/Vet.</p> <ul> <li>AultCare/AHF will provide reasonable accommodations to employees or applicants with disabilities, as defined by the Americans with Disabilities Act, who are otherwise qualified to safely perform the essential functions of the job, with or without accommodation, unless such accommodation would constitute an undue hardship on AultCare/AHF or poses a direct threat to the health and safety of the individual or others that cannot be sufficiently mitigated by reasonable accommodation. Any applicant or employee who requires an accommodation to perform the essential functions of his or her job or to enjoy equal benefits and privileges of employment should notify the AultCare Human Resource Department and request accommodation. </li></ul> <p>QUALIFICATIONS:</p> <ul> <li>Education: High School diploma or GED required </li><li>Medicare Part D experience preferred </li><li>CPhT or Pharmacy experience a plus but not required </li><li>Experience with Microsoft Office, including Excel, Word, Outlook and Power Point </li><li>Ability to type a minimum of 40wpm with accuracy. </li><li>Strong organization skills. </li><li>Self motivated </li><li>Excellent verbal and written communication skills. </li></ul> <p>WORKING CONDITIONS:</p> <ul> <li>Hours of operation, shifts as assigned. Occasional overtime. Must be available for on call shifts (evening, weekends and holidays). </li><li>Office environment with moderate noise level. </li><li>Frequent sitting, use of hands/fingers across keyboard or mouse, and long periods working at a computer. </li><li>Occasionally walking, standing, twisting/turning and reaching upward or forward during work day. </li></ul>