Part D Subject Matter Expert

Part D Subject Matter Expert

Location Columbia, MD

Job Code 2621

of Openings 1

Apply Now (https://phg.tbe.taleo.net/phg02/ats/careers/v2/applyRequisition?org=DCCAMD&cws=39&rid=2621)

DCCA is a veteran-owned IT business specializing in providing innovative solutions to a variety of government agencies and commercial enterprises since 1982. DCCA is proud to offer career growth opportunities and a competitive compensation and benefits package. Visit our website at: www.dcca.com

Part D Subject Matter Expert

Candidate must have or be willing to obtain a Public Trust Clearance

For over 40 years, DCCA has provided a broad range of IT services to government agencies and commercial enterprises, helping them to feel confident in their IT infrastructure. With DCCA, these organizations can be confident in the flexibility and skill of their IT partners, allowing them to upgrade their technology quickly and efficiently. Better yet, thanks to DCCA’s successful track record, clients can rest assured knowing DCCA can tackle any problem with ease, allowing them to focus on the work that matters.

Internally, DCCA prides itself on a culture built on integrity and inclusivity, allowing its employees to build lasting skills and relationships. As a veteran owned business, DCCA knows the importance of recruiting employees with a wide range of backgrounds, allowing for every problem to be approached by a diverse array of perspectives. Join us and be part of a team that has a people first mentality and dedication to excellence.

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.

At DCCA, we believe the key to providing our clients with unrivaled services starts with retaining top talent, something we’re able to do through our consistent commitment to building culture and comprehensive benefits.

Competitive Compensation: While salary at DCCA is determined by various factors, we are committed to making sure our salaries reflect the skill and expertise of our employees. In addition, each year we perform an annual salary review ensuring pay is equitable across both the company and industry at large.

Growth Opportunities: DCCA makes it a priority to help you grow and support your career advancement. From upskilling programs to recertification support, to professional development opportunities, we’re here to help you grow your career and create lasting relationships.

Emphasis on Inclusivity: DCCA’s culture emphasizes respect, equity, and opportunity and is supported by an array of business resource groups and other opportunities for connection.

Empowering Health: DCCA’s benefits which encompass healthcare, paid time off, and flexible 401(k) options encourage you to live a healthy and fulfilling life, both in and outside of work. Learn more about our total benefits package on our Benefits page (https://www.dcca.com/career/benefits) .

Mission Focused Work: From the defense industry to health IT management, DCCA allows you to work on innovative projects whose outcomes improve people's lives and solve today’s IT problems.

Equal Opportunity Employer including Disability/Vets