Medicare Pharmacy Analyst

Arkansas Blue Cross is only seeking applicants for remote positions from the following states:

Arkansas, Florida, Georgia, Illinois, Kansas, Louisiana, Minnesota, Mississippi, Oklahoma, South Carolina, Tennessee, Texas, Virginia and Wisconsin.

Workforce Scheduling

Remote

Job Summary

The Medicare Pharmacy Analyst is accountable for maintaining an ongoing assessment and interpretation of the Federal Regulations which pertain to both the Medicare Advantage and Prescription Drug programs. The Analyst must also monitor operational compliance. The specialist must be able to research, track and resolve complex issues involving several entities and programs.

Requirements

EDUCATION

High School diploma or equivalent required.

Bachelor's degree in related field. In lieu of degree, five (5) years' health related experience with health insurance, pharmacy, managed care, or healthcare related organization will be considered.

EXPERIENCE

Minimum three (3) years’ health related experience with health insurance, pharmacy, managed care, or healthcare related organization. Previous Medicare Part D and/or Pharmacy Claims experience preferred.

Must have served as project lead on one (1) large scale project and have successful completion of the project (e.g. implementation, issue tracking and resolution).

Proficient working knowledge of PC programs including experience with MS Office Suite.

Medicare Advantage experience preferred.

Prescription Drug Program experience preferred.

Medicare experience preferred.

Project Management experience preferred.

Experience in the area of extensive problem solving preferred.

Working knowledge of Pharmacy Benefit Manager (PBM's) preferred.

Prior quality assurance/testing experience related to claim adjudication & plan set-up preferred.

Prior coding experience preferred.

ESSENTIAL SKILLS & ABILITIES

Requires proficient interpersonal skills, including public speaking ability in order to make presentations to internal staff, CMS, auditors, etc.

Proficient analytical skills and methodologies.

Ability to effectively and efficiently communicate on a professional scale, both written and verbal communications.

Ability to work independently.

Ability to organize and coordinate workloads for maximum efficiency.

Ability to prepare a project plan, participate or lead special projects.

Ability to research and review several different issues from operational areas, coordinate with various operational owners to find a resolution, track the resolution to completion. This may be demonstrated via an assignment during the interview process.

Superior planning and coordinating skills preferred.

Ability to interpret requests from operational areas, and summarize changes needed in a clear and professional format, for a variety of audiences preferred. This will be demonstrated via an assignment during the interview process.

Skills

Responsibilities

Develops processes and procedures to gain efficiency in pharmacy administration., Oversees Pharmacy Benefits vendors and reviews claims for accuracy; submits changes and benefit builds to the PBM and quality assurance; reviews prescription drug events on a routine basis; reviews and develops letters, member documents and other materials as required for CMS compliance; monitors formulary and drug lists against claims history and published sources (web/formulary documents)., Reports routinely on issues, oversight and compliance related work., Serves as intake coordinator for prior authorization process for Medical covered drugs.

Certifications

Security Requirements

This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual.

Segregation of Duties

Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual.

Employment Type

Regular

ADA Requirements

1.1 General Office Worker, Sedentary, Campus Travel - Someone who normally works in an office setting or remotely and routinely travels for work within walking distance of location of primary work assignment.