Medicare Pharmacy Analyst Jobs

Medicare Pharmacy Analyst

3 months contract with our client (with possible extension)!

In this role you will contribute your expertise to ensure the accuracy, compliance, and efficiency of our Medicare Pharmacy Benefits. This is a 3-month project where you will have the opportunity to make a significant impact on our organization's pharmacy operations. Telecommuting is available for this role, and no travel is required. If you are a driven and detail-oriented professional with a strong background in Medicare Part D and pharmacy claims, we look forward to receiving your application.

Description:

As a Medicare Pharmacy Analyst, you will play a critical role in ensuring the accuracy and compliance of pharmacy benefits for our organization. You will oversee Pharmacy Benefits vendors, review claims, and make necessary changes to the Pharmacy Benefit Manager (PBM) system while maintaining a focus on quality assurance. Additionally, you will monitor prescription drug events, develop materials for CMS compliance, and perform formulary and drug list reviews against claims history and published sources. Your expertise will be essential as you serve as the intake coordinator for prior authorization processes related to Medical covered drugs.

Responsibilities:

• Oversee Pharmacy Benefits vendors and review claims for accuracy.
• Review prescription drug events on a routine basis.
• Submit changes and benefit builds to the PBM and ensure quality assurance.
• Develop letters, member documents, and other materials for CMS compliance.
• Monitor formulary and drug lists against claims history and published sources (web/formulary documents).
• Act as the intake coordinator for prior authorization process for Medical covered drugs.

Required Skills:

• Ability to develop processes and procedures to enhance efficiency in pharmacy administration.
• Knowledge of Medicare Advantage and Prescription Drug Program with a working understanding of Pharmacy Benefit Managers (PBMs).
• Experience in Project Management and the ability to prepare project plans and participate or lead special projects.
• Routinely report on issues, oversight, and compliance-related work.
• Minimum of three (3) years of health-related experience in health insurance, pharmacy, managed care, or a healthcare-related organization. Previous Medicare Part D and/or Pharmacy Claims experience preferred. Early to mid-level career stage with 4-5 years of post-school experience.
• Prior quality assurance/testing experience related to claim adjudication & plan set-up preferred. Previous claims coding experience is also desirable.
• Experience as a project lead on one large-scale project with a successful completion (e.g., implementation, issue tracking, and resolution).