Anthem, Inc. Business Change Manager (PS36232) in New Haven, Connecticut
SHIFT: Day Job
Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.
Business Change Manager (PS36232)
Office Based-Location(s): Mason, OH; Atlanta, GA; St. Louis, MO; Virginia Beach, VA; Morristown, New Jersey; Chicago, IL; Minneapolis/Minnetonka, MN; Louisville, KY; Wallingford, CT; Las Vegas, NV
The Business Change Manager is responsible for coordinating the activities of Prescription Drug Events (PDE) Operations. They ensure compliance with CMS and maximizing revenue thru PDE error corrections, overseeing other Part D activities, such as recoveries, CMS audits/Acumen, High Dollar Adjustment review, ESRD and Hospice adjustments. Accomplishes company objectives through information management. Supports customers in the areas of identifying Part D gaps and solutions, project management, data analysis and both routine and ad hoc reporting. Responsible for working with management to assist in oversight of Medicare PDE Operations and to develop/implement plans that support realization of business unit and enterprise goals.
Primary duties to include, but are not limited to:
· Understands how to build and maintain a business operation in managing and correcting CMS PDE Errors.
· Identification of Part D gaps and partaking or driving the solution via reporting or building new processes.
· Leads efforts to identify best practices across the pharmacy organization.
· Remain informed about regulatory and Medicare Part D pharmacy industry changes that have potential to impact our business.
· Builds support for business change throughout the business unit and cross functionality.
· Identifies potential issues, project charge, and scope.
· Identifies impacted parties, business partners, and resources required to correct identified issues.
· Develops and designs processes and systems that support business needs.
· Designs methods for integrating function and process.
· Conducts cost/benefit analyses.
· Requires a BA/BS degree in a related field;
· 5-8 years of process or project related experience that includes experience in successfully developing and managing projects with fairly significant operating budget and knowledge of process redesign; or any combination of education and experience, which would provide an equivalent background.
· 5-8 years of operational management and/or oversight experience in a pharmacy benefit management (PBM), Medicare Part D or a health plan setting.
· 5-8 years of PDE and claim adjustment experience.
· Medicare Part D, or other Government program experience required.
· Knowledge of Medicare Part D Coordination of Benefits (COB) desired.
· Knowledge of Medicare Secondary Payer processes desired.
· Must have an understanding of Center for Medicare and Medicaid (CMS) requirements and other industry changes that have potential impact to our business.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.