The Role

Under the leadership of the Clinical Pharmacy Account Relationship Manager, the Pharmacy Business Analyst performs a variety of functions supporting the Clinical Pharmacy Market Strategy teams to work efficiently, achieve team goals and deliverables. This role requires a strong background in data manipulation and analysis to meet various business and regulatory data/reporting requirements. In addition, the Pharmacy Business Analyst is responsible for developing and maintaining business workflows and related documentation, team dashboards to measure leading and lagging performance metrics, and pharmacist care management support via case prep, member/provider/pharmacy outreach, and identification of high-cost claim site of care opportunities.

SUMMARY OF RESPONSIBILITIES AND KEY RESULTS:

• • Successfully and independently manipulate and analyze pharmacy claims data and performance measurement in Excel and other systems, interpret findings to assist in the creation and execution of project plans, formulary communications, and provider communications.
  • Develop and maintain business workflows and related documentation and team dashboards to measure leading and lagging performance metrics.
  • Ensure accuracy in manipulating and maintaining data for projects to mitigate risk of errors and ensure data integrity.
  • Learn and maintain knowledge of BCBSMA systems including but not limited to: CVS CCA and pertinent systems within, ADT, IPRO, MHK, as well as other necessary systems.
  • Independently develop, support and track progress for quality initiatives designed to improve the overall health outcomes of our commercial members as measured by NCQA HEDIS 5-Star ratings.
  • Manage end to end data process for quarterly formulary change communications including Quality Assurance and coordination with PBM and internal business areas.
  • Manage end to end data process for monthly formulary file submissions to MA Health Connector for exchange business.
  • Lead and facilitate internal/external meetings related to team projects and take clear and concise meeting notes.
  • Independently perform research to prepare all necessary information needed for case management pharmacy review, including but not limited to calling provider offices, pharmacies and reviewing claims and clinical information in available systems.
  • Provide support to clinical pharmacy sales support team including reporting, issue management/research, RFP data analysis Quality Assurance, account specific marketing material data files, and presentation development.
  • Understand pharmacy business processes, drivers, and goals and uses business acumen and knowledge to drive success of business partners and enterprise, including through ongoing efficiency reviews of business processes.
  • Special projects as assigned.

EDUCATION AND EXPERIENCE REQUIREMENTS:

• • Bachelor's Degree or equivalent working experience.
  • 3-5 years' experience in managed care and/or pharmacy is required.
  • Experience in management of business functions and/or project management is preferred.
  • Advanced proficiency in standard computational office-suite applications including but not limited to, Microsoft Word, Excel and PowerPoint and relational database manipulation is required.

SKILL AND BEHAVIORAL COMPETENCIES REQUIRED:

• • Advanced proficiency in standard computational office-suite applications including, but not limited to Microsoft Word, Excel, PowerPoint, and relational database manipulation.
  • Ability to independently collaborate across internal and external teams.
  • Strong planning, prioritizing and execution skills as well as the ability to work independently to meet deadlines.
  • Excellent organizational, problem solving and communication skills.
  • Demonstrated strength in analysis, identification of problems and issue resolution.
  • Ability to multitask, be detail minded, and be results oriented.
  • Excellent skills in teamwork and team approaches to goal setting and attainment.

Minimum Education Requirements:

High school degree or equivalent required unless otherwise noted above

Location
HinghamTime Type
Full time

Salary Range: $89,820.00 - $109,780.00

The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee's pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.

This job is also eligible for variable pay.

We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.