Job Location: Morrisville, NC
Description
Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.
Job Summary:
The Pharmacy Solutions Analyst is responsible for a full range pharmacy benefit and clinical pharmacy project and operational support. These initiatives ensures operational effectiveness and excellence of the Managed Pharmacy Solutions (MPS) portfolio. This is a collaborative, dynamic role requiring critical thinking skills, independence, strategic mindset, attention to detail, and an ability to multi-task in a fast-paced environment. The position collaborates with operational teams to develop action plans for improving program performance with analytics, finance, and operations. This is a telecommuting position with occasional onsite work from our Morrisville, NC office.
Description of Job Responsibilities:
Project Support
- Provide project management support for operational initiatives that have impact on clients or vendors
- Investigates non-standard requests and problems, with some assistance from others
- Assists with tracking and trending of specified quality metrics including but not limited to HEDIS and other quality reporting as required
- Support report/dashboard distribution and day-to-day operation by developing the process, structure, methodologies, standards, guides, and SOPs.
- Must be able to run and troubleshoot reports/queries, reconcile data, and identify discrepancies in either raw or final data.
- Creates performance reports, dashboards & views for MPS leadership
- Work with Quality teams to develop reporting requirements that align with NCQA and URAC
- Develop standard reports and custom reports as needed
Client Support
- Assist in preparation and analysis of data related to client pharmacy contract obligations
- Audit Client Benefit Set Up
Temporary Implementation Support that includes but is not limited to :
- Ensure all implementation items are tracked, documented, and closed, in agreement with client intent.
- Provide timely and appropriate input to ensure implementations are on track for successful service and go live readiness.
- Develop and maintain strong interdepartmental relations and communication as it specifically relates to managed accounts including finance, IT, legal, sales, data, clinical and other departments as needed, to establish an understanding of client needs for implementation and ongoing services.
- Validate account set up in the current claims system to ensure adherence to plan documents.
- Schedule and lead Implementation meeting with new clients.
- Complete internal document with required data gathered from the Implementation meeting.
- Determine how enrollment and eligibility information will be provided.
- Verify and clarify all information leading to preparation of new plan administration and benefits design.
- Provide internal documentation of client’s plan design/administrative plan to all internal parties.
- Schedule and chair internal departmental meetings to review new client plan design.
- Perform other duties as assigned
Other Information
Education Requirements:
- Bachelor’s degree in Business Administration, Economics, Finance, Public Administration or related field (or equivalent combination of education, training and experience).
Licensure/Certification Requirements:
- No licensure or certification required.
Professional Experience Requirements:
- If a Bachelor’s degree: Two (2) years of experience in professional accounting, management of an operational unit, business analysis or financial analysis.
- If an Associate’s degree: Six (6) years of experience in professional accounting, management of an operational unit, business analysis or financial analysis.
- If a High School diploma or GED: Ten (10) years of experience in professional accounting, management of an operational unit, business analysis or financial analysis.
Knowledge/Skills/and Abilities Requirements:
Job Details
Legal Employer: STATE
Entity: Health Alliance
Organization Unit: Population Value Care Pharmacy
Work Type: Full Time
Standard Hours Per Week: 40.00
Work Schedule: Day Job
Location of Job: US:NC:Morrisville
Exempt From Overtime: Exempt: Yes
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