Full Job Description
Part D Subject Matter Expert
Candidate must have or be willing to obtain a Public Trust Clearance
Key Tasks:
• Serve as a Part D Subject Matter Expert providing detailed operational and technical guidance on E1 eligibility queries, FIR reporting, and TrOOP balance transfer processing across the Part D Transaction Facilitator platform
• Support quality assurance for the E1 eligibility environment, including application of minimum matching criteria and management of pharmacy exclusion tables
• Analyze and resolve complex transaction processing issues related to E1, FIR, TrOOP, and BIN/PCN routing, working directly with plan sponsors, pharmacies, and other payers/switches
• Support accurate, timely processing of FIR adjustments and reversals within industry-standard timeframes, and produce and validate related performance reporting
• Support development and refinement of transaction payer sheets, E1 matching logic, and BIN/PCN routing supplemental transaction specifications
• Serve as a technical resource to the Program/Deputy Program Manager and support CMS workgroup discussions on Part D COB operational matters
• Assist with monthly and quarterly reporting related to E1, FIR, and missing 4Rx data as required under the QASP performance framework
Required Skills
Proven experience:
• Hands-on, detailed operational experience with E1 eligibility transactions, FIR reporting, and TrOOP balance transfer processing within the Medicare Part D COB program
• Working knowledge of NCPDP E1 transaction standards, matching criteria, and BIN/PCN routing
• Analyzing and resolving complex pharmacy claims and eligibility transaction issues
• Serving as a Systems Analyst, Senior Systems Analyst, or Subject Matter Expert supporting a Medicare Part D eligibility, COB, or transaction facilitation platform
Desired Skills (Pluses)
Proven experience with:
• NCPDP standard pharmacy transactions (E1 and related transaction sets)
• An incumbent Part D COB Transaction Facilitator, Medicare Part D eligibility system, or similar CMS switch/clearinghouse contract
• Business Analysis, System Analysis, or similar function on a Part D contract that deals with E1, FIR, etc. transaction types
Required Education / Certifications
• Bachelor's Degree preferred (Health IT, Information Systems, Business, or related field)
The proposed salary range for this position in Maryland is 140,000 to 250,000. Final salary will be determined based on various factors. Our comprehensive benefit offerings include healthcare, retirement plan, paid disability and life insurance programs, employee assistance program, paid and unpaid leave programs, education assistance, and wellness initiatives.
