Register
Recruit Create CV
Unfortunately, this job posting is expired.
Don't worry, we can still help! Below, please find related information to help you with your job search.
Related keywords
Some similar recruitments
Medicare And Managed Medicaid Sales Director Remote
Recruited by Prime Therapeutics 8 months ago Address , Remote $106,800 - $170,600 a year
Myavatar Business Analyst Jobs
Recruited by Devereux Advanced Behavioral Health 8 months ago Address , Remote
Business Analyst Jobs
Recruited by Barclays 9 months ago Address , Whippany, 07981
Business Analyst Jobs
Recruited by Horizontal Talent 10 months ago Address Coon Rapids, MN, United States
Business Analyst Jobs
Recruited by Insight Global 10 months ago Address Johnston, IA, United States
Business Analyst Jobs
Recruited by Brooksource 11 months ago Address Cincinnati Metropolitan Area, United States
Business Analyst Jobs
Recruited by Zillow 11 months ago Address , Remote $69,300 - $110,700 a year
Frmc - Biller - Business Office
Recruited by St. Bernards Healthcare 11 months ago Address , Pocahontas, 72455, Ar
Business Analyst Jobs
Recruited by Dassault Falcon Jet 11 months ago Address , Little Rock, 72202, Ar
Business Analyst Jobs
Recruited by Capgemini 11 months ago Address , Des Plaines, Il
Carrier Benefit Advisor Jobs
Recruited by eHealth 11 months ago Address , Remote $65,000 a year
Medicare Billing Specialist Jobs
Recruited by Home Healthcare, Hospice & Community Services (HCS) 11 months ago Address , Remote
Benefit Marketing Analyst - Remote
Recruited by OneDigital 11 months ago Address , Remote
Program Director (Medicare) Jobs
Recruited by Cognosante, LLC 11 months ago Address , Remote $156,016 - $249,630 a year
Business Analyst Jobs
Recruited by Synergy TecHub 1 year ago Address Des Moines, IA, United States
Business Analyst Jobs
Recruited by Robert Half 1 year ago Address Pella, IA, United States
Marketing Analyst - Contract
Recruited by Intermedia.net, Inc. 1 year ago Address , Remote
Medicare Product Associate Jobs
Recruited by Devoted Health 1 year ago Address , Remote $88,100 - $98,700 a year
Um Administrative Coordinator- Medicare- Wah Mon-Fri 9Am-6Pm Est
Recruited by Humana 1 year ago Address , Tampa, 33610, Fl
Grievance And Appeals Representative 3
Recruited by Humana 1 year ago Address , Tampa, 33610, Fl
Supervisor, Medicare Sales Jobs
Recruited by eHealth 1 year ago Address , Remote
Medicare Advantage Appeals And Grievance Nurse
Recruited by Blue Cross and Blue Shield of Kansas City 1 year ago Address , Remote
Medicare Sales Manager Jobs
Recruited by ASSURANCE 1 year ago Address , Remote $80,000 - $82,500 a year
Professional Healthcare Biller Jobs
Recruited by Community Health Care 1 year ago Address , Tacoma, 98402, Wa $20.62 - $29.46 an hour
Qa Biller - Veterans Evaluation Services
Recruited by Maximus 1 year ago Address , Remote From $15 an hour
Remote Hmo Biller Jobs
Recruited by Corridor 1 year ago Address , Remote $18 - $22 an hour
Care Center Biller Jobs
Recruited by Privia Health 1 year ago Address , Remote $36,800 - $40,000 a year
Business Analyst Jobs
Recruited by City of Clarksville 1 year ago Address , Clarksville, 37040, Tn $61,774 - $92,661 a year
Senior Consultant-Pharmacy Business Manager
Recruited by Vizient, Inc. 1 year ago Address , Remote $88,900 - $132,250 a year

Pharmacy Benefit Analyst, Medicare

Company

Premera Blue Cross
Address , Remote
Employment type FULL_TIME
Salary $65,500 - $105,800 a year
Expires 2023-06-26
Posted at 1 year ago
Job Description
Join Our Team: Do Meaningful Work and Improve People’s Lives
Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.

To better serve our customers, we’re creating a culture that promotes employee growth, collaborative innovation, and inspired leadership.
Forbes ranked Premera among America’s 2022 Best Midsize Employers
because we are committed to creating an environment where employees can do their best work and where best-in-class talent comes, stays, and thrives!
COVID-19 Vaccination Policy:
To learn more about our COVID-19 vaccination and accommodation requirements, please visit our Careers landing page.
About the role of Pharmacy Benefits Analyst:
The Pharmacy Benefit Analyst acts as technical subject matter expert for the Pharmacy and Product Configuration teams on Pharmacy Benefit Manager (PBM) benefit coding and program, providing research, analysis, and support for wide range of processes, systems and workload issues. The Analyst plays a key role in: ensuring that pharmacy programming has been set-up accurately by the PBM vendor and provides quality assurance and testing related to claim adjudication and plan set-up; Providing oversight of all PBM data interfaces; Responding to inquiries and, collaborates with internal and external business partners to analyze and facilitate alternatives and recommendations for standard and custom PBM benefit configuration; Utilizing knowledge of Premera systems and processes as well as state and federal regulations and guidelines to identify risks and escalate possible PBM benefit configuration issues.
What you’ll do:
  • Develop training content and provide instruction to staff both 1:1 and in classroom setting. Work collaboratively with training staff in developing training programs.
  • Other duties as assigned.
  • Partner with customer service and contract services for language needed to develop and maintain the benefit quoting tool (BQT) database.
  • Provide technical support and partners with PBM vendor, and Premera pharmacy and product configuration teams to ensure pharmacy programming and systems have been set-up accurately according to pharmacy benefit coding, interpretation of pharmacy benefits and new pharmacy product builds.
  • Provide quality assurance and testing related to claim adjudication and plan set-up. Ensure all coding has been done appropriately and reviews system generated outputs to validate outcomes.
  • Provide oversight of all PBM data interfaces, by ensuring control points are in place to confirm delivery and receipt of files, accuracy for those files and that mapping of data fields is correct.
  • Research and provide direction to team on complex PBM benefit coding and compliance issues. Provide input to PBM vendor, IT and teams on custom benefit requests and make recommendations for alternative approaches. Identify, formulate, and approve criteria for new PBM programming logic related to benefit coding and monitor through final PBM testing.
  • Monitor delivery and tracking for wide range of inquiries, activities and workload within team providing direction to team members and on-going status reports to leadership.
  • Create, maintain and communicate detailed documentation, including workflow and process flows, policies, procedures, and action plans to address new and changing work to mitigate any risks. Develop processes and procedures for new and changing requirements.
  • Collaborate with cross functional Premera teams, including sales, system configuration, claims, contract services, group set-up, membership and billing, customer service, on feasibility and processing requirements for new and custom products and services, to identify implementation considerations for new products/groups, gap reviews, or to resolve system related issues.
What you’ll bring:
  • Experience in proactively applying analytical, problem solving and / or technical abilities to daily responsibilities.
  • Three years PBM technical experience in benefit coding or claims adjudication or related area which includes at least one year experience in PBM benefit configuration or equivalent. (Required)
  • Demonstrated ability to independently analyze pharmacy product designs and develop an alternative configuration approach to achieve desired outcome.
  • In-depth knowledge of pharmacy benefit coding.
  • Ability to organize and multi-task while maintaining strong attention to detail to ensure accuracy.
  • Demonstrated proficiency in Microsoft Word, Excel, PowerPoint and Outlook.
  • Must have Medicare Part D Benefit Experience
  • Ability to work independently and as a member of a team and influence others to resolve issues.
  • Demonstrated ability to effectively manage and prioritize a high volume of work effectively.
  • Ability to learn and effectively understand/utilize new concepts and functions quickly.
  • Bachelor’s degree or four years equivalent experience. (Required)
  • Washington pharmacy technician license. (Preferred)
  • Bachelor’s degree. (Preferred)
  • Previous experience troubleshooting production issues within claims or customer information systems or databases.
  • Previous experience in Premera product configuration. (Preferred)
  • Strong written and verbal communication skills, and ability to experience, establish and maintain effective relationships.
#LI – RS1
#LI - Remote
What we offer
  • Wellness incentives, onsite services, a discount program and more
  • Free parking
  • Life and disability insurance
  • Medical, vision and dental coverage
  • Retirement programs (401K employer match and pension plan)
  • Generous Paid Time Off to reenergize
  • Tuition assistance for undergraduate and graduate degrees
Equal employment opportunity/affirmative action:
Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.
If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at [email protected] or via phone at 425-918-4785.
The pay for this role will vary based on a range of factors including, but not limited to, a candidate’s geographic location, market conditions, and specific skills and experience.
National Salary Range:
$65,500.00 - $105,800.00
National Plus Salary Range:
$70,300.00 - $119,500.00
  • National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska.