Description and Requirements
Job Profile Summary The Sr. Pharmacy Benefits Analyst is responsible for leading and oversight of product strategy, benefit implementation, and performance of the prescription drug benefits via collaboration with the Pharmacy Benefit Manager (PBM) and other internal stakeholders.
- Identifies opportunity for operational improvement and leads the development of new pharmacy benefit capabilities to maximize performance.
- Leads the development of applicable policies and procedures, reporting and project specifications, job aids and workflows for Medicare products.
- Leads the setup and monitoring of Medicare pharmacy benefits and PDE accuracy in collaboration with our Pharmacy Benefit Manager (PBM).
- Collaborates with our Medicare product team to identify and implement benefit solutions to promote quality and achieve cost savings.
- Partners with Enrollment & Billing Department to establish processes to reconcile enrollment and eligibility data used to effectuate appropriate access to prescription drug benefit
- Review CMS communications related to Medicare Part D and leads implementation/response planning.
- Participate in and support the Medicare Bid and Go-To Market projects in collaboration with the clinical pharmacy team.
- Monitor and analyze key data and procedures for proper claims processing and adjudication system functionality.
- Perform Quality Control and Quality Assurance functions to assess information accuracy prior to report distribution.
- Provide timely support to other areas to verify and analyze claims processing cases, eligibility and other operational situations and/or issues as they relate to delegated functions.
- Partner with the Medicare Pharmacist to increase provider engagement via benefit and policy updates.
- Participates in training for new hires across HF departments.
- Additional duties as assigned.
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Minimum Qualifications
- HS Diploma/GED
Preferred Qualifications
- Bachelor's degree
- Base SAS certification
- Certified Pharmacy Technician
- MS Project: Ability to create schedules that include interdependencies, predecessors and successors between tasks. Must also be able to create baselines, provide milestone reports as well as manage resources and work hours.
- Experience working with a Pharmacy Benefit Manager (PBM) within a health plan or direct experience at a PBM that includes client facing interaction.
- 3+ years of Pharmacy benefits installation and testing experience
- Intermediate Excel, Microsoft, Word, and PowerPoint skills
Hiring Range:
- Greater New York City Area (NY, NJ, CT residents): $81,100 - $117,470
- All Other Locations (within approved locations): $71,600 - $106,505
As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.
In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.
The hiring range is defined as the lowest and highest salaries that Healthfirst in "good faith" would pay to a new hire, or for a job promotion, or transfer into this role.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.