Aridell Associates, LLC

​Serving tHE Healthcare,

Financial, Insurance, and Public SectorS

Current Job Opportunities

Job Title: Medicare Part D Subject Matter Expert (SME)
Post Date: 11/19/2018 – 12/31/2018

Position Summary
Aridell Associates, LLC, a professional consulting firm, advises clients on healthcare program operations and helps clients develop solutions to maximize meaningful outcomes, improve their operations, and protect their valuable assets, as well as bestow customer confidence in their operations.  Our mission is to advance clients’ operational performance and provide sustainable long-term, successful business strategies.

If you are interested in providing consulting and advisory services or supporting contracts, then this consulting position is for you.  The Medicare Part D SME works as an integral member of a multi-disciplinary team in supporting contracts and clients on health plan operational and government program matters. In this position, you will focus on prescription drug benefit operations and serve as a subject matter expert in analyzing healthcare claims and encounter data, answering healthcare coding and clinical questions, identifying coding disconnects, and explaining the coding of procedures and services.

Responsibilities

  • Research and answer prescription drug coding questions posed by clients and team members.
  • Interpret policies, laws, rules, regulations, and healthcare industry guidelines (e.g., NCDs, LCDs, drug compendia).
  • Conduct formulary administration; coverage determinations, appeals, and grievances; pharmacy network management and contracting; prescription drug claims; rebate management; medication therapy management; and clinical safety audits. 
  • Support audits, data analysis projects, operational plans, and statistical sampling designs.
  • Educate and explain healthcare payment models (e.g., risk adjustment payment models), coding practices, and the coding process to clients and team members as needed.
  • Prepare standard and ad hoc deliverables for clients.
  • Verify and validate National Drug, healthcare procedure, and service codes when requested.
  • Provide subject matter expertise on Medicare Part D, Medicaid, and other government healthcare programs’ operations.
  • Communicate responses during face-to-face and virtual meetings with the client and team members to address inquiries.
  • Serve as a technical resource in coding and reimbursement systems.
  • Maintain a detailed level of knowledge of Medicare and Medicaid coding guidelines, other payer rules, and ICD-9, ICD-10, HCC, RxHCC, CPT, DRG, HCPCS, and NDC coding.


Qualifications

  • Requires a postgraduate degree in a healthcare related field.
  • Requires a minimum of 3 years of experience in a clinical or healthcare administration setting.
  • Requires a minimum of 10 years of professional experience with a minimum of 5 years of first-hand experience with government healthcare programs.
  • Doctor of Pharmacy Required.


 Skills

  • Medicare Part D Subject Matter Expert shall be able to demonstrate knowledge and a thorough understanding of the following:

            - Medicare Part A, Part B, Part C, and Part D programs.
            - Medicaid programs.
            - Health plan, prescriber, provider, pharmacy, pharmacy benefit manager, and supplier operations.
            - Healthcare delivery, billing, and coding processes.
            - Federal and state healthcare programs’ operations, regulations, manuals, and processes.

  • Experience with a variety of electronic health records is preferred.
  • Ability to work under pressure and short deadlines.
  • Requires excellent professional presentation skills.
  • Strong organizational, planning and prioritization skills with the ability to collaborate with others and multi-task.
  • Ability to analyze data and conduct research to draw conclusions and provide solutions.
  • Thorough understanding of billing forms, Remittance Advices, Explanations of Benefits and provider billing statements.
  • Excellent written and verbal communication skills.
  • Ability to present to large or small groups when required.
  • Solid computer proficiency with the Microsoft Office Professional Suite, including Word, Excel, Access, PowerPoint, and Outlook.


Travel Requirements
Expected travel > 20 percent. 

Job Location
This is a work-from-home/remote position.

Apply Now
Email Resume To: jarias@aridell.com

Job Title: Medicare Part C and Part D Consultant
Post Date: 11/19/2018 – 12/31/2018

Position Summary
Aridell Associates, LLC, a professional consulting firm, advises clients on healthcare program operations and helps clients develop solutions to maximize meaningful outcomes, improve their operations, and protect their valuable assets, as well as bestow customer confidence in their operations.  Our mission is to advance clients’ operational performance and provide sustainable long-term, successful business strategies.

If you are interested in providing consulting and advisory services or supporting contracts, then join us as a consultant.  The Medicare Part C and Part D Consultant works as an integral member of a multi-disciplinary team in supporting contracts and clients on health plan operational and government program matters. In this position, you will serve as a subject matter expert in conducting audits of health plan operations, such as, but not limited to, agent/brokers; enrollment and eligibility; data collection, reporting, and submission; claims processing; marketing; utilization review; quality management; coordination of benefits; records retention; compliance program activities; and plan bids.

Responsibilities

  • Interpret Medicare Part C and Part D policies, laws, rules, regulations, manuals, and healthcare industry guidelines.
  • Conduct compliance and program audits (i.e., planning, risk assessment, fieldwork, and reporting), data analysis projects, operational plans, and statistical sampling designs.
  • Educate and explain healthcare payment models (e.g., capitation and risk adjustment payment models), coding practices, and the coding process to clients and team members as needed.
  • Analyze Medicare Part C encounter data and Medicare Part D prescription drug event records.
  • Prepare standard and ad hoc deliverables for clients.
  • Verify and validate compliance with Federal and state regulatory requirements.

  • Provide subject matter expertise on Medicare Part C and Part D, Medicaid, and other government healthcare programs’ operations.
  • Communicate responses during face-to-face and virtual meetings with the client and team members to address inquiries.
  • Serve as a technical resource in health plan operations and data.
  • Possess a working knowledge of Medicare information systems.
  • Maintain a detailed level of knowledge of Medicare and Medicaid coding guidelines, other payer rules, and ICD-9, ICD-10, HCC, RxHCC, CPT, DRG, HCPCS, and NDC coding.


Qualifications

  • Requires a postgraduate degree in a Public Administration, Science, Project Management, Business, or other relevant field.
  • Requires a minimum of 5 years of auditing experience in a health plan setting.
  • Requires a minimum of 10 years of professional experience with a minimum of 5 years of first-hand experience with government healthcare programs.


 Skills

  • Medicare Part C and Part D Subject Matter Expert shall be able to demonstrate knowledge and a thorough understanding of the following:

            - Medicare Part A, Part B, Part C, and Part D programs.

            - Medicaid programs.

            - Health plan, prescriber, provider, pharmacy, pharmacy benefit manager (PBMs), and supplier operations.

            - Healthcare delivery, billing, and coding processes.

            - Federal and state healthcare programs’ operations, regulations, manuals, and processes.

  • Requires experience in healthcare delivery and prescription drug industry practices.
  • Experience with a variety of electronic health records is preferred.
  • Ability to work under pressure and short deadlines.
  • Requires excellent professional presentation skills.
  • Strong organizational, planning and prioritization skills with the ability to collaborate with others and multi-task.
  • Ability to analyze data and conduct research to draw conclusions and provide solutions.
  • Thorough understanding of billing forms, Remittance Advices, Explanations of Benefits and provider billing statements.
  • Excellent written and verbal communication skills.
  • Ability to present to large or small groups when required.
  • Solid computer proficiency with the Microsoft Office Professional Suite, including Word, Excel, Access, PowerPoint, and Outlook.


Travel Requirements
Expected travel > 20 percent. 

Job Location
This is a work-from-home/remote position.

Apply Now
Email Resume To:jarias@aridell.com