Pharmacy Analyst

Position: Pharmacy Analyst

Location: Philadelphia PA

Duration: 4 months

Job Description: 

The primary purpose of the job is to:

• To maintain, review, and provide consultation on basic to moderately complex customer benefits. The benefit claims analyst also analyses claims reports to identify trends, issues, and present recommendations.

• Maintains current knowledge of Medicare requirements related to Part D Chapters 5, 6, and 14 as they pertain to benefits and claims adjudication

• Researches benefit and claims related inquiries

• Makes recommendations for fulfilment of basic to moderately complex benefit requests

• Documents benefit design specifications for submission to the claims processing vendor

• Prepares test plans, scenarios, and executes testing

• Monitors and reports claims activity based upon benefit set-up to ensure accurate processing according to the approved requirements from the customer

• Troubleshoots reported claims defects and provides detailed summary of analysis and all available solutions for immediate mitigation

• Processes claims transaction requests (rework)

• Makes recommendations to management based upon trend analysis

• Reviews and writes comprehensive reports, identifies alternatives, and makes recommendations to management.

• Participation including leading of audits related to benefit or claims activity

• Performs other related duties and projects as assigned by the department Director or Regional Supervisor.

• Supports and carries out the PerformRx Mission & Values.

• Maintains a current knowledge base of PerformRx programs, services, policy and procedures.

• Regularly reviews and adheres to standard operating guidelines, desktop procedures, checklists, templates, and memorandums issued to the department.

• Creates and supports an environment which fosters teamwork, cooperation, respect and diversity.

• Establishes and maintains positive communication and professional demeanor with PerformRx employees and customers at all times.

• Demonstrates and supports commitment to corporate goals and objectives

Bachelor s Degree:

• 3 to 5 years PBM, pharmacy operations, or claims processing experience required

• Progressive and focused work experience in continuous improvement initiatives, project management, and/or organizational development.

• CPhT certification preferred