Pharmacy Operations Analyst

1 week ago


Southfield Michigan, United States TEKWISSEN LLC Full time
Position Title:
Pharmacy Operations Analyst

Work Location:
Remote

Contract Duration:
12 Months

Job Type:
Contract

Work Type:
Onsite

Department:
Medicare Pharmacy Operations

Role Overview:


The Pharmacy Operations Analyst plays a crucial role in supporting Medicare Advantage plans in adhering to CMS compliance standards related to Pharmacy Benefit Manager (PBM) oversight, reporting, and benefit configuration.


Key Responsibilities:


1. Enhance workflows and business processes to elevate customer satisfaction, reduce operational expenses, and boost overall service quality.
2. Provide assistance to Customer Service teams by addressing inquiries and delivering clear, concise information.
3. Support CMS and internal audits by preparing necessary documentation and facilitating reviews.
4. Analyze business challenges and develop effective solutions.
5. Lead projects to achieve targeted outcomes and communicate results effectively.
6. Recommend and help implement standardized policies and procedures.
7. Ensure ongoing compliance with corporate policies and practices.
8. Participate in system testing and contribute to process improvements.
9. Assist internal and external personnel by providing information and training.
10. Foster strong relationships with clients and stakeholders.
11. Engage in discussions within teams or committees.


Educational Background:
A Bachelor's degree in a relevant field is preferred, though a combination of education and experience may be acceptable. Continuous professional development is expected as per the company's learning philosophy.

Experience Requirements:
A minimum of four years of experience in a related field is essential, preferably within health plans or PBM environments. Proficiency in Microsoft Office Suite, particularly Excel, Word, and Outlook, is required. Candidates should possess strong data analysis and problem-solving skills, along with experience in resolving eligibility and pharmacy claims issues.

Skills and Competencies:
  • In-depth knowledge of pharmacy claim processing and Medicare Part D regulations.
  • Exceptional organizational skills with the ability to manage multiple tasks effectively.
  • Willingness to learn and take on additional responsibilities as needed.
  • Experience with PBM systems and tools.
  • Strong analytical, planning, and problem-solving abilities.
  • Excellent written and verbal communication skills.
  • Capability to interpret technical documents and communicate effectively with diverse audiences.

TEKWISSEN LLC is committed to fostering a diverse workforce and is an equal opportunity employer.

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