Pharmacy Benefits Management PBM SME and Business Analyst
The Computer Merchant, LTD.
Waimanalo, HI(remote)
JOB DETAILS
SALARY
$50–$55 Per Hour
JOB TYPE
Temporary, Contractor, Full-time
SKILLS
Adjudication, Business Analysis, Business Processes, Business Skills, Centers for Medicare and Medicaid Services (CMS), Claims Processing, Communication Skills, Compensation and Benefits, Data Analysis, Data Modeling, Design Document, Documentation, Drug Design, Federal Laws and Regulations, Formulary, Industry/Trade Analysis, Medicaid, Microsoft Excel, Microsoft PowerPoint, Microsoft Visio, Microsoft Word, Pharmacy, Preferred Drug List, Pricing, Process Development, Product Requirements Document (PRD), Quality Assurance, Regulations, Requirements Management, SQL (Structured Query Language), Software Development Lifecycle (SDLC), State Laws and Regulations, Team Player, Test Plan/Schedule, Use Cases, Utilization Management, Wireframes, Writing Skills
LOCATION
Waimanalo, HI
POSTED
25 days ago
JOB LOCATION: Remote
WAGE RANGE*: $50HR TO $55HR W2
JOB NUMBER: 26-00111
REQUIRED EXPERIENCE:
Provide PBM Subject Matter Expertise for both (Development and Testing team) and stakeholders (e.g. Customers)
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.
JOB DESCRIPTION
We are looking to onboard a Senior Business Analyst in Manager role or Individual contributor depending on experience level. This person will have deep PBM domain expertise and who will help guide the roadmap and feature enhancements for the clients PBM product suite. This person will serve as a bridge between the Business users and/or Clinical end users (Pharmacists) and the Technical team (Developers and Testers primarily).
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)
Non-Domain Expertise:
- Must understand Software Development Life Cycle - including requirements management.
- Must be able to capture requirements, document requirements and manage requirements using requirements management tools.
- Must be able to document business processes using a combination of tools - Visio, Powerpoint, Excel and Word formats depending on the context and synthesize requirements into user stories, decision tables or other pertinent formats
- Must have excellent communication and writing skills.
- Experience with SQL queries and understanding Data Models is a strong plus.
- Must be a team player willing to share knowledge and support team members from other areas e.g. Developers and QA Testers.
Job Responsibilities:
- Provide PBM Subject Matter Expertise for both (Development and Testing team) and stakeholders (e.g. Customers)
- Own responsibility for creating requirements specifications / design documents (e.g. wire-frames, decision tables) to help developers produce technical specifications.
- Own responsibility for configuring drug plan benefits (e.g. Covered drugs, Pricing configuration, PA requirements) using Conduent PBM system
- Interact with business and clinical users to elicit and understand business requirements, Translate the requirements into appropriate format for consumption by Development and Testing team.
- Good working knowledge on creating Process workflow or Use Cases, Powerpoint slides, Wireframes, Workflows using Microsoft Visio, Analyze data using Microsoft Excel is needed to be effective at Requirements management, Translating and simplifying requirements.
- Document product features/requirements related documentation, prepare roadmaps (with aid of tools such as Visio, Power point)
Equal opportunity employer as to all protected groups, including protected veterans and individuals with disabilities
* While an hourly range is posted for this position, an eventual hourly rate is determined by a comprehensive salary analysis which considers multiple factors including but not limited to: job-related knowledge, skills and qualifications, education and experience as compared to others in the organization doing substantially similar work, if applicable, and market and business considerations. Benefits offered include medical, dental and vision benefits; dependent care flexible spending account; 401(k) plan; voluntary life/short term disability/whole life/term life/accident and critical illness coverage; employee assistance program; sick leave in accordance with regulation. Benefits may be subject to generally applicable eligibility, waiting period, contribution, and other requirements and conditions. Benefits offered are in accordance with applicable federal, state, and local laws and subject to change at TCM's discretion.
About the Company
T
The Computer Merchant, LTD.
About TCM
If you would like to…
- Develop your skills
- Improve your earnings potential
- Gain greater control over your career
The Computer Merchant, Ltd. (TCM) has provided Information Technology Solutions and enterprise staffing services to Fortune 1000, mid to small sized corporations, as well as Federal, state, and local governments for over 30 years.
At The Computer Merchant (TCM), we are committed to your professional and financial success. We'll evaluate your background, experience and qualifications, and then recommend contract jobs that are the best match for your goals.
Fast Facts & Recognition:
- 41 year track record of success deploying over 63,000 consultants and core employees in critical positions for Fortune 1000 companies
- Access to over 11 million unique consultants nationwide
- Centralized and dedicated client delivery team
- Supplier Diversity Certification as a Veteran Business Enterprise
COMPANY SIZE
1,500 to 1,999 employeesINDUSTRY
Staffing/Employment Agencies
FOUNDED
1980
WEBSITE
http://itstaffing.com/