Job Description
This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Pharmacy Analyst I supports daily operational functions and oversight of the SCAN Pharmacy Benefit Management (PBM) company on delegated Part D activities. This role assists with maintaining compliance with Part D deadlines and regulatory timeframes. Under guidance, the Analyst I provides support in managing Eligibility files, Prescription Drug Event (PDE) data, Drug Plan Finder submissions, Financial Information Reporting, and other key functions to help ensure adherence to Medicare requirements. • Serve as a subject matter expert for Part D Reporting requirements, Pharmacy Access Requirements, Prescription Drug Event data, Financial Information Reporting and Drug Plan Finder files by keeping up to date with Medicare requirements. • Ensure eligibility and coordination of benefit files are sent to the PBM for processing and assess if file enhancements are needed. • Ensure the PBM is processing Prescription Drug Events, Automated Claims Reprocessing and Financial Information Data according to CMS regulatory standards by conducting daily oversight. • Ensure PBM oversight of claims adjudication and retrolics and ensure 1/1 Readiness related to eligibility. • Analyze and monitor large data sets that are exchanged from SCAN to the PBM using a variety of reporting tools. • Ensure audit documentation is prepared according to audit instructions and provided within the specified audit time frame. • Prepare written responses or documentation for pharmacy audits. • Perform routine monitoring to ensure Part D compliance and detect performance issues or operational gaps. • Assist in the implementation, testing, and validation of pharmacy benefits to ensure accurate benefit configuration and claims adjudication. • Collaborate with cross-functional teams, including Compliance, Product, and IT, to address issues and support PDE and other pharmacy initiatives. • Identify and escalate issues related to pharmacy benefits, claims processing, and PDE submissions, working with the PBM and internal teams to resolve discrepancies. • Maintain professional and technical knowledge by attending educational workshops; reviewing professional publications & CMS regulatory requirements; establishing personal networks; participating in professional societies. • Contribute to the development, maintenance, and documentation of standard operating procedures (SOPs) and desktop procedures to support compliance and operational efficiency. • Actively support the achievement of SCAN’s Vision and Goals. • Other duties as assigned. Qualifications • 0-3 years of related experience. • High School Diploma or equivalent experience required. • Bachelor's Degree or equivalent experience preferred. • Expert knowledge of CMS Part D regulations e.g., CMS Call Letters, MA-PD application, PDE, LICS, Claims Processing, Part D Reports, FIR. • Knowledge of PDE calculations that pertain to Enhance Alternative Plans, Coverage Gap, etc. • Ability to prioritize workload to meet deadlines. • Ability to multi-task in a fast pace environment. • Ability to interact effectively and professionally with all levels of staff. • Excellent grammar and writing skills. • Excellent verbal skill sets to be able to communicate in conference calls and in large meetings. • Team player with a strong work ethic. • Self-starter that can take the lead on a project and manage its progress for completion. • Detail oriented and is able to work with large data sets. • Advanced skills with Microsoft Office (e.g., Word, Excel, Access, Outlook, and PowerPoint) and SQL. • Familiarity with Tableau and Visio. Benefits • Base salary range: $25.38 to $36.76 per hour. • Internal title: Pharmacy Analyst I. • Work Mode: Remote. • An annual employee bonus program. • Robust Wellness Program. • Generous paid-time-off (PTO). • 11 paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday. • Excellent 401(k) Retirement Saving Plan with employer match and contribution. • Robust employee recognition program. • Tuition reimbursement. • An opportunity to become part of a team that makes a difference to our members and our community every day! Apply tot his job