Pharmacy Configuration Services Analyst

Genesis10 is currently seeking a Pharmacy Configuration Services Analyst for a 6 month contract to hire role with our client in the insurance industry in Bloomington, MN. This role 100% Remote.

Summary:

Provide support to the Pharmacy Administration department including:

• Development and support of moderate to complex pharmacy plan design set up for "Client " members.
• Assist in pharmacy benefit administration including working with network management and monitoring, research and answering questions to support Sales and Marketing as well as the Pharmacy Customer Service partners.
• Coordinate group benefit relationships with the Pharmacy Benefit Manager (PBM) including, but not limited to, benefit creation, claims analysis and network management.
• Using knowledge of Pharmacy, combined with an understanding of data and reporting structures available, ensures that data is reported consistently and accurately when requested by departmental leadership.
• Support of applications by participating in design of system specifications, testing, development of resource materials, and serving as a resource to business areas for process issues and troubleshooting.
• Maintain a working knowledge of essential databases and applications including key definitions, relational structure as well as significant coding systems.
• Maintain a thorough and comprehensive understanding of state and federal requirements (statutory and regulatory) and accreditation standards for all lines of business (Commercial, Exchange, State Public Programs, and Medicare).
• When problems are identified, assist with corrective action plan documentation and issue resolution.

Responsibilities:

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

Required Qualification:

• 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

Preferred Qualifications:

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

Compensation:

Hourly W2 pay rate $24.00 to $28.00/Hr.

We have access to additional contract, contract-to-hire, and direct hire positions with various rate ranges.

If you have the described qualifications and are interested in this exciting opportunity, apply today!

Ranked a Top Staffing Firm in the U.S. by Staffing Industry Analysts for six consecutive years, Genesis10 puts thousands of consultants and employees to work across the United States every year-in contract, contract-for-hire, and permanent placement roles. With more than 300 active clients, Genesis10 provides access to many of the Fortune 100 firms and a variety of mid-market organizations across the full spectrum of industry verticals.

Benefits of Working with Genesis10:

• Access to hundreds of clients, most who have been working with Genesis10 for 5-20+ years.
• The opportunity to have a career-home in Genesis10; many of our consultants have been working exclusively with Genesis10 for years.
• Access to an experienced, caring recruiting team (more than 7 years of experience, on average.)
• Medical, Dental, Vision
• Health Savings Account
• Voluntary Hospital Indemnity (Critical Illness & Accident)
• Voluntary Term Life Insurance
• 401K
• Sick Pay (for applicable states/municipalities)
• Commuter Benefits (Dallas, NYC, SF, and Illinois)
• Remote opportunities available

For multiple years running, Genesis10 has been recognized as a Top Staffing Firm in the U.S., as a Best Company for Work-Life Balance, as a Best Company for Career Growth, for Diversity, and for Leadership, amongst others. To learn more and to view all our available career opportunities, please visit us at our website.

Genesis10 is an Equal Opportunity Employer. Candidates will receive consideration without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.