Pharmacy Configuration Services Analyst

HealthPartners • Bloomington, MN

6d

About The Position

HealthPartners is hiring a Pharmacy Configurations Service Analyst. This role provides support to the Pharmacy Administration department, focusing on the development and support of moderate to complex pharmacy plan design setup for HealthPartners members. The analyst will assist in pharmacy benefit administration, including working with network management and monitoring, and researching and answering questions to support Sales and Marketing, as well as Pharmacy Customer Service partners. A key responsibility is coordinating group benefit relationships with the Pharmacy Benefit Manager (PBM), which includes benefit creation, claims analysis, and network management. The role requires using knowledge of pharmacy, combined with an understanding of data and reporting structures, to ensure consistent and accurate data reporting as requested by departmental leadership. Additionally, the analyst will support applications by participating in the design of system specifications, testing, developing resource materials, and serving as a resource for business areas regarding process issues and troubleshooting. Maintaining a working knowledge of essential databases and applications, including key definitions, relational structure, and significant coding systems, is crucial. A thorough understanding of state and federal requirements (statutory and regulatory) and accreditation standards for all lines of business (Commercial, Exchange, State Public Programs, and Medicare) is also necessary. When problems are identified, the analyst will assist with corrective action plan documentation and issue resolution.

Requirements

• Bachelor’s Degree in Health Care Administration, Business, or related field OR at least five years of experience in pharmacy claims processing, benefits, and management.
• Two years experience in pharmacy claims processing, benefits, management, contract implementation, or related experience.
• Strong computer skills with Microsoft Excel, Word, Access or related applications.
• Exceptional analytical skills
• Strong problem-solving skills
• Excellent oral and written communication skills

Nice To Haves

• Medicare Part D, Medicaid and Exchange experience
• Knowledge of HealthPartners systems

Responsibilities

• Develops understanding for pharmacy plan designs
• Interprets and evaluates unique, specific and complex pharmacy benefit designs
• Integrates pharmacy benefits with various internal departments for claims processing: Formulary administration, Specialty program management, Membership Accounting, Product & Market Innovations, Contracts & Benefits, Medical Claims
• Supports implementation of P&T Committee coverage decisions, including PBM set-up, drug list implementation and maintenance of pharmacy clinical programs.
• Creates and coordinates accurate pharmacy benefit set up with PBM
• Communicates and documents benefit design and coverage intent to the PBM
• Tracks and maintains pharmacy benefits through databases, spreadsheets, and matrixes
• Reviews final benefit design for accuracy through claims analysis
• Knowledge of information data transfers with PBM
• Attends appropriate meetings as needed
• Assists in monitoring the performance of the PBM
• Develop and maintain essential reports in order to produce routine and ad hoc reports to ensure timely and accurate dissemination of information
• Provide appropriate written and verbal communication to team members, managers and customers regarding issue identification and resolution
• Maintains accuracy and confidentiality of data
• Maintains accuracy and confidentiality of documentation
• Proactively identify and address data quality issues
• Suggest alternative strategies as appropriate
• Assists in the creation of policy and procedures
• Demonstrates HealthPartners core values: Passion, Integrity, Teamwork and Respect
• Demonstrates responsiveness to and appreciation of constructive feedback and recommendations for person growth and development
• Maintain confidentiality of information with the utmost rigor in accordance with HealthPartners corporate policies
• Supports Pharmacy Compliance Activities
• Performs other duties as assigned

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level