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Job Requirements of Pharmacy Claims Configuration Analyst:
Responsibilities:
- Develops understanding for pharmacy plan designs
- Interprets and evaluates unique, specific and complex pharmacy benefit designs
- Integrates pharmacy benefits with various internal departments for claims processing: Formulary administration, Specialty program management, Membership Accounting, Product & Market Innovations, Contracts & Benefits, Medical Claims
- Supports implementation of P&T Committee coverage decisions, including PBM set-up, drug list implementation and maintenance of pharmacy clinical programs.
- Creates and coordinates accurate pharmacy benefit set up with PBM
- Communicates and documents benefit design and coverage intent to the PBM
- Tracks and maintains pharmacy benefits through databases, spreadsheets, and matrixes
- Reviews final benefit design for accuracy through claims analysis
- Knowledge of information data transfers with PBM
- Attends appropriate meetings as needed
- Assists in monitoring the performance of the PBM
- Reporting and Documentation
- Develop and maintain essential reports in order to produce routine and ad hoc reports to ensure timely and accurate dissemination of information
- Provide appropriate written and verbal communication to team members, managers and customers regarding issue identification and resolution
- Maintains accuracy and confidentiality of data
- Process Development
- Maintains accuracy and confidentiality of documentation
- Proactively identify and address data quality issues
- Suggest alternative strategies as appropriate
- Assists in the creation of policy and procedures
- Demonstrates HealthPartners core values: Passion, Integrity, Teamwork and Respect
- Demonstrates responsiveness to and appreciation of constructive feedback and recommendations for person growth and development
- Maintain confidentiality of information with the utmost rigor in accordance with HealthPartners corporate policies
- Supports Pharmacy Compliance Activities
- Performs other duties as assigned
Required Qualification:
- Bachelor's Degree in Health Care Administration, Business, or related field OR at least five years of experience in pharmacy claims processing, benefits, and management.
- Two years experience in pharmacy claims processing, benefits, management, contract implementation, or related experience.
- Strong computer skills with Microsoft Excel, Word, Access or related applications.
- Exceptional analytical skills
- Strong problem-solving skills
- Excellent oral and written communication skills
Preferred Qualifications:
-
- Medicare Part D, Medicaid and Exchange experience
Do you meet the requirements for this job?
Pharmacy Claims Configuration Analyst
Genesis10
Bloomington, MN (Onsite)
Contract to Hire
$24.00 - $28.00/Hour
Provide support to the Pharmacy Administration department including:
- Development and support of moderate to complex pharmacy plan design set up for 'Client ' members.
- Assist in pharmacy benefit administration including working with network management and monitoring, research and answering questions to support Sales and Marketing as well as the Pharmacy Customer Service partners.
- Coordinate group benefit relationships with the Pharmacy Benefit Manager (PBM) including, but not limited to, benefit creation, claims analysis and network management.
- Using knowledge of Pharmacy, combined with an understanding of data and reporting structures available, ensures that data is reported consistently and accurately when requested by departmental leadership.
- Support of applications by participating in design of system specifications, testing, development of resource materials, and serving as a resource to business areas for process issues and troubleshooting.
- Maintain a working knowledge of essential databases and applications including key definitions, relational structure as well as significant coding systems.
- Maintain a thorough and comprehensive understanding of state and federal requirements (statutory and regulatory) and accreditation standards for all lines of business (Commercial, Exchange, State Public Programs, and Medicare).
- When problems are identified, assist with corrective action plan documentation and issue resolution.
Job Requirements:
Responsibilities:
- Develops understanding for pharmacy plan designs
- Interprets and evaluates unique, specific and complex pharmacy benefit designs
- Integrates pharmacy benefits with various internal departments for claims processing: Formulary administration, Specialty program management, Membership Accounting, Product & Market Innovations, Contracts & Benefits, Medical Claims
- Supports implementation of P&T Committee coverage decisions, including PBM set-up, drug list implementation and maintenance of pharmacy clinical programs.
- Creates and coordinates accurate pharmacy benefit set up with PBM
- Communicates and documents benefit design and coverage intent to the PBM
- Tracks and maintains pharmacy benefits through databases, spreadsheets, and matrixes
- Reviews final benefit design for accuracy through claims analysis
- Knowledge of information data transfers with PBM
- Attends appropriate meetings as needed
- Assists in monitoring the performance of the PBM
- Reporting and Documentation
- Develop and maintain essential reports in order to produce routine and ad hoc reports to ensure timely and accurate dissemination of information
- Provide appropriate written and verbal communication to team members, managers and customers regarding issue identification and resolution
- Maintains accuracy and confidentiality of data
- Process Development
- Maintains accuracy and confidentiality of documentation
- Proactively identify and address data quality issues
- Suggest alternative strategies as appropriate
- Assists in the creation of policy and procedures
- Demonstrates HealthPartners core values: Passion, Integrity, Teamwork and Respect
- Demonstrates responsiveness to and appreciation of constructive feedback and recommendations for person growth and development
- Maintain confidentiality of information with the utmost rigor in accordance with HealthPartners corporate policies
- Supports Pharmacy Compliance Activities
- Performs other duties as assigned
Required Qualification:
- Bachelor's Degree in Health Care Administration, Business, or related field OR at least five years of experience in pharmacy claims processing, benefits, and management.
- Two years experience in pharmacy claims processing, benefits, management, contract implementation, or related experience.
- Strong computer skills with Microsoft Excel, Word, Access or related applications.
- Exceptional analytical skills
- Strong problem-solving skills
- Excellent oral and written communication skills
Preferred Qualifications:
-
- Medicare Part D, Medicaid and Exchange experience
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Salary Details
This salary was provided in the Job Posting.
$24-$28
Hourly Salary