Healthcare Pharmacy Business Analyst
InnoSoul•Raleigh, NC
•Hybrid
About The Position
This position will be responsible for managing the relationship between the Division's pharmacy program and the system functionality that enforces the business rules and requirements specific to pharmacy operations within the Medicaid program. NC DHHS Division of Health Benefits is seeking a Business Systems Analyst. This position will be responsible for managing the relationship between the Division's pharmacy program and the system functionality that enforces the business rules and requirements specific to pharmacy operations within the Medicaid program.
Requirements
- Experience with Pharmacy claim adjudication Required 3 Years
- Working knowledge of First Data Bank (FDB) drug classifications such as therapeutic drug classes, NDCs, GSNs, GCNs, etc.), drug dosage, packaging/pric Required 3 Years
- Understanding of Medicaid PDL (for generic and brand drugs) Required 3 Years
- Understanding of preferred/non-preferred drug, prior authorization criteria/rules, lock-in program requirements and drug utilization review Required 3 Years
- Experience with gathering requirements and interpreting business rules Required 3 Years
- Highly proficient with Microsoft Outlook, Word and Excel Required 3 Years
- Excellent communication, negotiation, conflict resolution and persuasion abilities Required 3 Years
Nice To Haves
- Experience with Pharmacy claim adjudication
- Working knowledge of First Data Bank (FDB) drug classifications such as therapeutic drug classes, NDCs, GSNs, GCNs, etc.), drug dosage, packaging and pricing
- Understanding of Medicaid PDL (for generic and brand drugs), preferred/non-preferred drug, prior authorization criteria/rules, lock-in program requirements and drug utilization review (both ProDUR and RetroDUR).
- Experience with gathering requirements and interpreting business rules
- Demonstrated ability to work independently in a fast-paced environment with concurrent deadlines
- Excellent communication, negotiation, conflict resolution and persuasion abilities
- Strong organizational, time management, communication, and detail-oriented skills
- Highly proficient with Microsoft Outlook, Word and Excel.
Responsibilities
- Monitor PHP data reports and identify issues
- Research Pharmacy issues
- Identify defects and track to resolution
- Request system enhancements and track to resolution
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
