Responsibilities/Tasks

• Assist with all functions related to Pharmacy Benefit Manager (PBM) oversight for Medicare Advantage Part D plans.

• Receive and respond to plan related member and provider inquires.

• Troubleshoot problems, inquiries, and provide timely response.

• Works with internal and external partners to ensure compliance with CMS regulations.

• Performs routine tracking, auditing, and reporting of performance in relation to CMS requirements.

• Supports the organization in the event of an internal or external audit.

• Coordinate review of Part D member and provider communications.

• Recommends and assists with development of policies and procedures and desk level guides.

• Assists personnel (both internal and external) by answering questions, supplying information, and maintaining metric and performance dashboards.

• Assist in monitoring reports to track operational effectiveness and vendor service levels.

• Report reconciliation in multiple software environments.

• Proficiency with and responsibly for pulling data reports from readily available databases and reporting tool.

• Maintain drug lists and HCPCs changes or updates.

• Perform other related duties as assigned.

o Top 3 Required Skills/Experience – The most important must-have skills.

• Retail Pharmacy, Healthplan, PBM or related experience – at least 2 years

• Strong computer skills and use of existing software packages (Excel, Power Point, Word, Outlook, etc.)

• Knowledge of claims processing and prescription drug names

o Required Skills/Experience

• Detail Oriented

• Organization and time management skills, as evidenced by the capacity to prioritize multiple tasks and job duties/responsibilities.

• Capability to work independently and efficiently complete tasks in a fast-paced environment.

• Ability to read and interpret process workflows.

• Strong interpersonal communication skills and experience with interacting across multiple departments.

o Preferred Skills/Experience – Optional but preferred skills/experience.

• CMS Part D knowledge & CMS regulations

• Knowledge of PBM systems and tools

• Healthplan experience

o Education/Certifications – Optional but preferred

• CPhT preferred (Certified Pharmacy Tech licensed)

• High school diploma or GED

Category Analyst

Function Information Technology

Req ID JN -062024-121285