Commercial Drug Analyst
1 month ago
- Support the pharmacy strategy from a Commercial drug benefit design and delivery perspective.
- Maintain a deep understanding of Commercial drug benefits.
- Work with internal HMSA staff to ensure HMSA Commercial drug plans are competitive and compliant.
- Collaborate with other departments including MPD, Fed87 and CPO to assess new contractual and plan requirements and determine implementation needs for compliance.
- Review and assessment of utilization and drug spend to identity opportunities.
- Benefit Design and Delivery
- Work with internal HMSA staff to understand the intent of the update/change requested. Work with the Pharmacy Benefit Manager (PBM) to implement the change.
- Analyzes business problems, including, but not limited to new benefit changes or products, formulary changes, enhancements to add functionality and/or redesigns of systems to improve efficiency.
- Implement, test, and evaluate changes made within the PBM.
- Defines acceptance testing criteria and ensure that the criteria are met before system changes are implemented.
- Maintain PBM system functionality to ensure operational efficiency.
- Monitor and evaluate accuracy of pharmacy drug benefit through testing review and validations; report monitoring and/or live claim review.
- Ensure HMSA meets performance standards state by employer groups, Blue Cross Blue Shield Association, or government regulations, in addition to internal policies, procedures, workflows or business requirements
- AMS Support
- Triage, track and respond to inquiries to ensure servicing needs are properly identified and addressed.
- Identify areas for improvement.
- Identify areas for improvement.
- Support AMS with employer group reporting needs and asks.
- Provide RFP Support.
- Work with PM staff to address and respond to RFP questions
- Work with PM staff to address and respond to RFP questions
- Triage, track and respond to inquiries to ensure servicing needs are properly identified and addressed.
- Project Coordination & Implementation
- Manage projects related to implementing clinical initiatives and/or pharmacy benefit operations and improvements.
- Review and edit requirements, specifications, business processes and recommendations related to proposed solution.
- Provide quality, objective, and professional analysis of business needs and PBM capabilities/limitations.
- Conducts research, evaluation of measures and value assessments of initiatives and/or programs.
- Coordinates and facilitates planning, tracking, and installation of business requirements.
- Assess compliance with Federal and State regulations, internal policies, procedures, and workflows
- Manage inquiries coming to Pharmacy Management
- Triage, track and respond drug plan inquiries to ensure member servicing needs are properly identified and addressed.
- Coordinates problem solving associated with inquiries.
- Performs QI efforts to identify gaps and opportunities for improvement.
- Other Duties and Functions
- Performs all other miscellaneous responsibilities and duties as assigned or directed.
- Performs all other miscellaneous responsibilities and duties as assigned or directed.
#LI-Hybrid
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