Analyst, Pharmacy Configuration Services - Bloomington, United States - HealthPartners
Description
The purpose of this position Pharmacy Configuration Services role is to provide support to the Pharmacy Administration department including: Development and support of moderate to complex pharmacy plan design set up for HealthPartners 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.
ACCOUNTABILITIES:
Develops understanding for pharmacy plan designs
Interprets and evaluates unique, specific and complex pharmacy benefit designs
Integrates pharmacy benefits with various internal departments for claims processing: Formulary administration, Specialty program management, Membership Accounting, Product & Market Innovations, Contracts & Benefits, Medical Claims
Supports implementation of P&T Committee coverage decisions, including PBM set-up, drug list implementation and maintenance of pharmacy clinical programs.
Creates and coordinates accurate pharmacy benefit set up with PBM
Communicates and documents benefit design and coverage intent to the PBM
Tracks and maintains pharmacy benefits through databases, spreadsheets, and matrixes
Reviews final benefit design for accuracy through claims analysis
Knowledge of information data transfers with PBM
Attends appropriate meetings as needed
Assists in monitoring the performance of the PBM
Reporting and Documentation
Develop and maintain essential reports in order to produce routine and ad hoc reports to ensure timely and accurate dissemination of information
Provide appropriate written and verbal communication to team members, managers and customers regarding issue identification and resolution
Maintains accuracy and confidentiality of data
Process Development
Maintains accuracy and confidentiality of documentation
Proactively identify and address data quality issues
Suggest alternative strategies as appropriate
Assists in the creation of policy and procedures
Demonstrates HealthPartners core values: Passion, Integrity, Teamwork and Respect
Demonstrates responsiveness to and appreciation of constructive feedback and recommendations for person growth and development
Maintain confidentiality of information with the utmost rigor in accordance with HealthPartners corporate policies
Supports Pharmacy Compliance Activities
Performs other duties as assigned
REQUIRED QUALIFICATIONS:
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
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.