Pharmacy Operations Analyst

Viva Health•Birmingham, AL

1d•Hybrid

About The Position

The Pharmacy Operations Analyst is responsible for the daily tasks, functions, monitoring, and reporting related to pharmacy benefit administration for the Commercial and Medicare lines of business. This role is responsible for collaborating with the Pharmacy Benefit Manager(s) (PBM) to maintain and update pharmacy benefits, research and manage claims payment anomalies and inquiries, and maintain processes required to support accurate claims payment and compliance with pharmacy related regulatory requirements. This position works with the Operations team to resolve pharmacy-related member and provider escalations and general pharmacy related issues.

Requirements

Bachelor's degree or equivalent experience
5 - 7 years’ experience with a Health Plan, Part D, Pharmaceutical Business, Pharmaceutical Industry, PBM, etc.
Excellent interpersonal skills for frequent interaction with staff, other departments, management, providers, employer groups, and external vendors
Excellent critical thinking and analytical abilities
Access, Word, Excel, and PowerPoint at an intermediate skill level (Power Query)
Excellent written and oral communication skills including public speaking

Nice To Haves

Experience with a PBM or Pharmacy in a position that required understanding of pharmacy claims and drug reimbursement as it relates to health insurance

Responsibilities

Perform operational monitoring of the PBM, including claims issue tracking, eligibility file monitoring, error identification and follow-up, accumulation file validation, and operational support ticket tracking.
Perform functions and tasks related to required reporting, including Prescription Drug Event (PDE) acceptance rate, claim reject reporting, hospice and End Stage Renal Disease (ESRD) reporting, and Financial Information Reporting (FIR).
Routine operational dashboard creation to monitor key performance indicators to analyze task-related effectiveness and opportunities for increased efficiency.
Monitor and track metrics and markers related to member experience and work with management to identify strategies that could lead to improved member experience.
Collaborate with the Operations team and PBM account manager to implement strategic initiatives and projects, assess accuracy of benefit administration, track open issues log and trends.
Support ongoing operational processes to maintain compliance with regulatory requirements.
Support Operations team to handle escalated pharmacy related member and provider issues and inquiries.
Maintain up to date documentation of operational processes and procedures, as well as assist with development of new processes and procedures.
Participate in internal and external audit activities, that may include gathering documentation, collection of evidence, tracking log audits, and correction action monitoring.