65 to 90K

Responsible for designated analytics and reporting processes, which include obtaining and analyzing information and writing reports related to pharmacy operations. Provide recommendations on continuous improvement to the reporting process while seeking out opportunities for improved performance within the company. Frequently work on ad hoc projects or participate in cross-functional teams.

Responsibilities:

• Provide technical support of Clinical Operations programs and processes as assigned.
• Assist Pharmacists with monitoring and evaluation of pharmacy claims, requirements documentation, and testing. Identify issues and problems areas and participate in development and implementation of solutions.
• Perform routine reporting and analysis on Rx claims, PDE and clinical programs.
• Perform reporting and analysis on STARS program related to pharmacy, clinical and operations elements
• Maintain current understanding of Medicare Part D coverage and benefit plans in order to accurately analyze and prepare Medicare claims data for internal analysis
• Analyze and reconcile PDE entries rejected by CMS, including adjustments related to eligibility, TrOOP, cost sharing, and LICS status.
• Coordinate projects and processes with other business units (e.g. Information Technology, Data Analysis, Process Integrity) and vendors.
• Assist with quality assurance review and monitoring of data files
• Participate in development and maintenance of CMS-required documentation and reporting.
• Enter data within web-based workflow management program and manage workflow tasks as required.
• Ability to multi-task within multiple systems and source programs.

Skills:

• Experience operating in Windows, Microsoft Office tools (Excel, PowerPoint, Word, Internet Explorer) and web-based applications
• Experience with Business Objects, Crystal Reporting or SQL preferred
• Strong data entry skills and experience in manipulating and reviewing large datasets in Microsoft Excel.
• Superior communication, organization, and prioritization skills
• Strong analytical skills with attention to detail
• Courteous and professional demeanor with the desire and ability to work as a team
• Ability to work independently, self-starter
• Knowledge of medical and drug terminology and pharmaceutical calculations
• Knowledge of third party insurance and payment options
• 2 or more years experience in process improvement, analysis or project management
• 3 or more years pharmacy related experience required, prior managed care experience preferred

Education/Certifications:

Bachelor’s degree in Finance, Healthcare Administration, Accounting or related field preferred with an Associates Degree required.