Medicare Part D SME & COB Solutions Expert

DCCA; Columbia (MD); On-site; USD 140,000 - 250,000; Full time

Job summary

DCCA in Maryland is seeking a Part D Subject Matter Expert to provide detailed operational and technical guidance on E1 eligibility, FIR reporting, and TrOOP balance transfers across the Part D Transaction Facilitator platform.

The role demands hands-on Medicare Part D COB experience and the ability to analyze complex transaction issues, collaborating with plan sponsors, pharmacies, and payers. A Bachelor's degree is preferred and willingness to obtain a Public Trust clearance is noted.

Qualifications

• Proven experience with E1 eligibility transactions, FIR reporting, and TrOOP balance transfer processing.
• Working knowledge of NCPDP E1 transaction standards, matching criteria, and BIN/PCN routing.
• Analyses and resolves complex pharmacy claims and eligibility transaction issues.
• Experience as a Systems Analyst, Senior Systems Analyst, or SME supporting Medicare Part D COB/transaction platforms.

Responsibilities

• Serve as Part D SME providing detailed guidance on E1 eligibility queries and TrOOP balance transfers.
• Support QA for the E1 environment, including minimum matching criteria and pharmacy exclusion tables.
• Analyze and resolve transaction processing issues across E1, FIR, TrOOP, BIN/PCN routing with payers/switches.
• Support FIR adjustments and reversals within standard timeframes and produce performance reports.
• Contribute to development and refinement of transaction payer sheets and E1 matching logic.
• Assist CMS workgroup discussions on Part D COB operational matters and provide reporting support under QASP.

Skills

E1 eligibility processing

FIR reporting

TrOOP balance transfers

NCPDP E1 standards

BIN/PCN routing

Pharmacy claims analysis

Systems Analyst / SME

CMS COB experience

Education

Bachelor's degree (Health IT/ Information Systems / related)

Job description

DCCA in Maryland is seeking a Part D Subject Matter Expert to provide detailed operational and technical guidance on E1 eligibility, FIR reporting, and TrOOP balance transfers across the Part D Transaction Facilitator platform.

The role demands hands-on Medicare Part D COB experience and the ability to analyze complex transaction issues, collaborating with plan sponsors, pharmacies, and payers. A Bachelor's degree is preferred and willingness to obtain a Public Trust clearance is noted.