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Pharmacy Benefits Analyst
2 months ago
Greetings,
My name is Poornachandra Rao, and I am a recruiter with KYYBA. We focus on connecting skilled professionals with opportunities that match their expertise. I found your profile and believe you could be an excellent match for a current opening. Below is the job description for your consideration.
Position Title: Pharmacy Benefits Analyst
Location: Remote
Contract Duration: Long Term
Overview:
The Pharmacy Benefits Analyst role involves supporting Medicare Advantage plans in adhering to CMS compliance standards related to pharmacy benefit management. This position also includes responsibilities for reporting and benefit configuration. The listed hourly rate is an estimate and may vary based on negotiations.
Key Responsibilities:
1. Enhance workflows and business processes to elevate customer service, reduce operational expenses, and boost overall quality.
2. Provide assistance to Customer Service by addressing inquiries and delivering clear responses.
3. Support CMS and internal audits by preparing necessary data.
4. Analyze business challenges and develop effective solutions.
5. Lead projects to achieve targeted outcomes.
6. Communicate project results effectively across the organization.
7. Recommend and help implement standardized policies and procedures.
8. Ensure ongoing communication and monitoring of corporate compliance.
9. Participate in system testing and contribute to process improvement recommendations.
10. Assist both internal and external personnel by providing information and training.
11. Cultivate and maintain strong relationships with clients.
12. Engage in discussions within groups or committees.
Qualifications:
A Bachelor’s degree in a relevant field is preferred, although a combination of education and experience may be acceptable. Continuous professional development is expected as per the company’s learning philosophy.
Experience Required:
- Minimum of four years in a related field, preferably within health plans or pharmacy benefit management.
- Proficiency in Microsoft Office Suite, including Excel, Word, and Outlook.
- Strong data analysis and problem-solving capabilities, with experience in spreadsheets and databases.
- Familiarity with resolving pharmacy claims and eligibility issues.
- Experience in responding to CMS inquiries regarding pharmacy claims.
Skills and Knowledge:
1. Understanding of pharmacy claim processing and Medicare Part D regulations.
2. Strong organizational skills with the ability to prioritize tasks effectively.
3. Willingness to learn and take on additional responsibilities as needed.
4. Experience with pharmacy benefit management systems and tools.
5. Ability to interpret and respond to inquiries from external stakeholders accurately.
6. Proven analytical skills with a focus on operational and data analysis.
7. Excellent written and verbal communication skills.
8. Capacity to lead and contribute to process improvement initiatives.
9. Ability to understand and interpret technical documents and manuals.
