Business Analyst (Medicaid and PBM Domain) - Remote

EXPERIENCE LEVEL:

• Ideally 10+ years experience working in PBM domain (Claims processing related).
• Willing to consider less experienced candidates who can demonstrate depth in understanding PBM area.

PBM SUBJECT MATTER EXPERTISE:

• Candidate should have deep understanding of Pharmacy Benefit Management (PBM) business processes – including Claims Adjudication, Data related processes (e.g. Eligibility data, Provider data, Drug data, Formulary data, Drug Utilization reviews) and their interconnections. Strong plus if candidate has experience with Electronic Prescriptions and Prior-Authorizations related standards.
• Deep understanding of related PBM standards from NCPDP. Strong plus if candidate also understands CMS regulations related to state Medicaid Pharmacy programs.
• Candidate should have deep understanding of Financial Bank (FDB) Drug nomenclature and how to use FDB nomenclature in designing / configuring drug coverage (inclusions/exclusions/PA Criteria) or building Formulary / Preferred Drug Lists. In lieu of FDB, MEDISPAN data experience will be acceptable.
• Candidate should be well informed about current industry trends and evolving standards.
• College degree is preferred. Industry experience can be considered as substitute.
• Candidates who have strong Clinical background (e.g. Pharmacists) and some BA background are welcome to apply (provided they are willing to switch to being a full-fledged BA with inhouse training)