Pharmacy Benefit Management (PBM) Business analyst

Apply for this position Please mention DailyRemote when applying
timePosted 13 days ago location United States salarySalary undisclosed
Before you apply - make sure the job is legit.

Attempting to apply for jobs might take you off this site to a different website not owned by us. Any consequence as a result for attempting to apply for jobs is strictly at your own risk and we assume no liability.

Job Description

Overall Experience level 10+ years Required skills The ideal candidate must possess excellent background on Pharmacy Benefit Management (PBM) business and Rx domain spectrum. At least 2 years working experience in Business engagements in healthcare industry, preferably in Pharmacy Benefit Manager (PBM) Pharmacy spectrum Pharmacy Benefit Manager (PBM) Pharmacy spectrum as Business Analystndash with core Business team More than 3 years total healthcare experience Demonstrated Working experience in Payer-PBM interfaces(few key entities from PharmacyPBM spectrum) Subrogation Claim Processing Member Eligibility ProductBenefit Claim Processing Prior Authorization Formulary ConsumerMember portals Mobility applications MedicareMedicaid, PDE, Encounter Coordination of Benefits NCPDP layout and EDI Rx transactions Specialty Pharmacy Mail order Pharmacy Excellent knowledge in Elicitation of Business requirements by collaborating with Business sponsors Efficient in translating Business Requirements into Functional and Non-Functional Requirements Strong communication skillset who can be engaged with business stakeholders as Pharmacy domain SME Experienced in User Acceptance Testing (UAT) Strong exposure to Agile and Waterfall - Model and tools(eg JIRA, Confluence etc) Good to have- Working experience with PBM migration with any of the leading Payers (Anthem, Aetna, United etc) Certified in Agile practices - SAFeRegistered Practitioner, Scrum Master etc Certifications in Business Analysis Responsibilities- As a Pharmacy Benefit Management (PBM) Business Analyst, you will Process the PBM claims based on business rules Engage appropriate PBM business stakeholders in reviewing business scenarios and revise the business rules as required Collaborate with other business functional groups including (but not limited to) Membership and Enrolments, Benefit Configuration, Pricing and Networks, Formulary management, Drug Discounts, Finance and Reporting, Downstream processing areas Run query from data warehouse applications and claims processing application (s) to triage the reported claims and related issues Facilitate andor actively participate in meetings related to the designated projects, both locally and internationally, with clients andor partners Accurately track and report claim status Support claims review and audit activities