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Pharmacy Business Systems Analyst - Managed Care

Company: Providence
Location: Beaverton
Posted on: November 18, 2022

Job Description:

**Description****Providence is seeking a Pharmacy** **Business Systems Analyst - Managed Care** **who will:**+ Design, develop, and execute the business requirements necessary to assure the accurate processing of prescription claims at participating pharmacies utilizing eligibility, benefits, formularies and drug utilization management edits in a point-of service environment.+ Coordinate between internal departments and contracted vendors and interpretation of regulatory requirements.+ Focus on developing a proactive, evidence-based pipeline approach to assess high impact novel therapeutic medications, as well as collaborating with our provider partners on initiatives that drive value based care.**Major Challenges:**+ Complex work involving multiple vendors and PHP; requiring high pharmacy and technical/IS knowledge of systems.+ On-line real time pharmacy claims adjudication system that must function 24x7 with limited 'downtime'. Rotating 'on call' work required to support 24/7 requirements.+ Coordination with multiple PHP departments to accomplish all work & objectives.+ Deadlines, short turnaround time requirement to meet business needs, requirement for accuracy to promote quality.+ Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision.+ Ability to work in a stressful environment and take action as required to mediate risk.**In this position you will:**+ Assess and determine key attributes of pharmacy claims systems and other software utilized in the pharmacy department necessary to develop and execute tools that take into consideration the unique needs of individuals at various stages of life from the neonate to the geriatric member and throughout the continuum.+ Coordinate systems configurations and maintenance of systems with contracted vendor for pharmacy claims for all lines of business.+ Coordinate implementations of formulary and utilization management decisions.+ Evaluate the return of paid pharmacy claims to PHP. Remediates discrepancies for all lines of business and assure that records and adjustments are managed according to regulatory requirements.+ Coordinate system impact of new pharmacy products, network contract administration, implementation of state and federal mandates, software upgrades, operational workflow discussions, and benefit structural decisions.**Job Specific Knowledge, Skills and Abilities:**+ Overall knowledge and understanding of assigned applications specifically Argus Health Systems and PRIME Therapeutics or another NCPDP format prescription drug processing vendor.+ Ability to design basic reports and extracts - to include the ability to identify to others assigned the primary responsibility of reporting the necessary requirements and data fields necessary for reports required to meet business objectives.+ Documented knowledge and expertise in pharmacy benefit administration including current issues and challenges facing this industry.+ Demonstrated excellent analytical and problem-solving skills and methods.+ Demonstrates enhanced written communication skills by creating and maintaining accurate technical documentation to support Argus and Wellpoint Next Rx applications.+ Makes presentations to managers, directors, vendors, and staff at level appropriate for position.+ Exhibits group facilitation skills to help teams develop sound business decisions.+ Ability to interact and effectively communicate with all levels of the organization in a meaningful manner suited toward the needs and background of the individual.+ Demonstrates understanding of the business and pharmacy provider environments wherein PHP is responsible for providing pharmacy benefit management services.+ Knowledge of Pharmacy Software Systems used external to PHP.+ Knowledge of various drug data bases such as Medispan, FDB preferred as is knowledge of software tools designed to translate data into information - e.g. Sequel, Cognos, or other.+ Sharepoint knowledge preferred.**Required qualifications:**+ Bachelor's Degree Business Administration, Healthcare Administration or Healthcare related field. Or equivalent education/experience+ Coursework/Training: Medication and drug product category training and medical terminology.+ 5 years of experience as a Pharmacy Technician or directly related field.+ 1 year of managed care pharmacy experience.**Preferred qualifications:**+ Coursework/Training: Project management, Six Sigma Change Acceleration Process (CAP), LEAN, and Work Out training.+ Project management, Six Sigma Change Acceleration Process (CAP), LEAN, and Work Out experience.+ Sharepoint experience.**Our** **best-in-class benefits** **are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our** **Mission** **of caring for everyone, especially the most vulnerable in our communities.****About the department you will serve.**Providence Strategic and Management Services provides a variety of functional and system support services for all eight regions of Providence from Alaska to California. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.**About Providence**At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.**Requsition ID:** 112373 **Company:** Providence Jobs **Job Category:** Analytics/Business Intelligence **Job Function:** Information Technology **Job Schedule:** Full time **Job Shift:** Day **Career Track:** Business Professional **Department:** 5018 PHARMACY OR REGION **Address:** OR Beaverton 3601 SW Murray BlvdProvidence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

Keywords: Providence, Beaverton , Pharmacy Business Systems Analyst - Managed Care, Healthcare , Beaverton, Oregon

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