Pharmacy Analyst
1 week ago
CLIENT JOB ID: 98821
Our client is searching for an experienced Pharmacy Analyst with knowledge in Medicare Part D claims processing and end to end business processes to join our team Pharmacy Experience Team supporting activities related to resolving complex Medicare Part D Pharmacy member inquiries. These inquiries can include and are not limited to complaints to Medicare and grievances related to Medicare Part D. In this role, you will report to the Pharmacy Experience Manager and play a key role in ensuring the integrity of the Medicare Part D plan administration.
Team Breakdown: Close knit team who works together to resolve member escalations.
Director Business Process Consultant 3 Managers 12 AnalystsKey Position Responsibilities:
Serve as dedicated resource to multiple complex Medicare Part D plans to manage first level response and resolution of escalated pharmacy issues with both internal and external internal clients, typically direct contact via phone, email or SharePoint site. Understand the overall business model of Medicare Part D products, CMS guidance, the Pharmacy Benefit Manager (PBM) claim adjudication system and translate concepts into practice. Using knowledge of Medicare Part D and claims processing be able to identify unique issues and areas of concern that are not predefined or prescribed but rather identified through the examination of complex claims activities to determine appropriate course of action and provide that direction to the PBM to act on the part of the plan and the member. Participate in all 1/1 readiness activities related to preparation for new benefit plan year. Familiarize self with all custom plan nuances and rules to support all issues and inquiries for the new plan year. Partner with Product and Clinical teams to resolve any inquiries related to the Medicare Part D plan including Mail Order Pharmacy. Investigate enrollment, billing, claim and/or customer service issues as identified and communicate resolution to both internal and external clients. Must be a self-managed individual capable of identifying, prioritizing, and organizing own work to meet deadlines and expectations.Qualifications:
Required:
3 years Medicare Part D/Pharmacy benefit, and/or PBM experience related to eligibility, benefits and/or claims adjudication Minimum of 1 years’ experience Pharmacy claim analysis and quality practicesPreferred:
BA / BS degree preferred or equivalent work experience Knowledge of RxClaim processing system Proficiency with Microsoft Word, Excel, PowerPoint, SharePoint and Visio Knowledge of Medicare Part D guidelines and regulations Experience with Prior Authorization systems and guidelines in compliance with CMS regulation Ability to effectively prioritize multiple tasks, priorities, projects and deadlines Proven success in business analysis and continuous process improvement Strong development, analytical, detail-oriented, organization, problem-solving and follow-through skills Ability to analyze large amounts of data and handle complex requests Demonstrated problem solving skills Ability to build strong business relationships Excellent oral and written and presentation skills for external clients as well as internal leadership stakeholders.Does this position require a professional license or certification? If so please list. No, but Pharmacy Tech license would be preferred.
- **Only those lawfully authorized to work in the designated country associated with the position will be considered.**
- **Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client’s business needs and requirements.**
Benefits:
For information and details on employment benefits offered with this position, please visit here. Should you have any questions/concerns, please contact our HR Department via our secure website.
California Pay Equity:
For information and details on pay equity laws in California, please visit the State of California Department of Industrial Relations' website here.
Rose International is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender (expression or identity), national origin, arrest and conviction records, disability, veteran status or any other characteristic protected by law. Positions located in San Francisco and Los Angeles, California will be administered in accordance with their respective Fair Chance Ordinances.
If you need assistance in completing this application, or during any phase of the application, interview, hiring, or employment process, whether due to a disability or otherwise, please contact our HR Department.
Rose International has an official agreement (ID #132522), effective June 30, 2008, with the U.S. Department of Homeland Security, U.S. Citizenship and Immigration Services, Employment Verification Program (E-Verify). (Posting required by OCGA 13/10-91.).
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