Responsible for identifying, collecting, analyzing, and maintaining data to evaluate issues that support prospective business decisions. Coordinate projects for senior management. Bachelor's Degree in Business Administration, Health Care, or a related field is preferred. Two (2) or more years of experience in related field required.

RESPONSIBILITIES/TASKS:

• Researches, analyzes, identifies, and evaluates data from assigned problems to evaluate existing and potential trends and issues.

• Possesses and maintains a comprehensive understanding and knowledge of Healthcare business, products, programs (including provider data, networks, etc.), corporate organizational structure (including functional responsibilities), and basic research principles/methodologies.

• Assists in the management and monitoring of multiple projects simultaneously by establishing project plans and objectives to ensure goal attainment within defined parameters.

• Communicates results of analysis to management via reports/presentations and assists management in implementing programs that provide solutions.

• Recommends and implements solutions to identified problems/root cause of issues.

• Provides expertise and guidance to unit and corporate staff as required.

• Represents and participates in group or committee discussions.

• Supports PBM audit and analytics to support Medicare pharmacy services business team.

• Builds and supports business reports to be included in executive dashboard.

• Assist with all functions related to Pharmacy Benefit Manager (PBM) oversight for Medicare Advantage Part D plans.

• Receive and respond to plan related member and provider inquires.

• Troubleshoot problems, inquiries, and provide timely response.

• Works with internal and external partners to ensure compliance with CMS regulations.

• Performs routine tracking, auditing, and reporting of performance in relation to CMS requirements.

• Supports the organization in the event of an internal or external audit.

• Coordinate review of Part D member and provider communications.

• Recommends and assists with development of policies and procedures and desk level guides.

• Assists personnel (both internal and external) by answering questions, supplying information, and maintaining metric and performance dashboards.

• Assist in Monitoring reports to track operational effectiveness and vendor service levels.

• Report reconciliation in multiple software environments.

• Maintain drug lists and HCPCs changes or updates for Part B Utilization Management.

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

Top 3 Required Skills/Experience – The most important must-have skills.

• Health plan, PBM or related experience – at least 2 years

• Strong computer skills and use of existing software packages (Excel, Power Point, Word, Outlook, etc.)

• Knowledge of claims processing and prescription drug names

Required Skills

• Working knowledge of Medicare Part B and Part D

• Ability to plan, organize, direct, and control projects.

• Ability to lead and contribute to process improvement projects.

• Strong communication skills with the ability to understand, interpret, and communicate ideas.

• Strong knowledge and use of existing software packages (PowerPoint, Excel, Word, etc).

• Strong analytical, organizational, planning, and problem-solving skills.

• Ability to effectively interface with employees at all levels.

• Ability to understand and apply statistical inference.

Preferred Skills

• CMS Part D knowledge & CMS regulations

• Knowledge of PBM systems and tools

• Health plan experience

Education

• Bachelor's degree preferred

Category Analyst

Function Information Technology

Req ID JN -102024-121666