- Core responsibilities will involve operational management and oversight of the Pharmacy Benefit Manager(s) (PBM).
- Manage, and oversee Medicare Part D requirements and corresponding operational processes. Including, but not limited to: Payment integrity - PDE/Encounter Data, FIR's, NX Transactions, and Coordination of Benefits., coverage decisions and appeals, claims, benefits, formulary/PDL, networks and materials
- Establish PBM KPIs and Program dashboards to manage and measure outcomes related to performance guarantees.
- Draft and maintain policies related to core job responsibilities.
- Collaboratively work with internal and external partners, clients, and vendors.
- Intake, manage, and resolve inquiries, issues, or requests for information received from members, groups, Clients, CMS/DHS and/or any other channel.
- Help prepare and disseminate dashboards and/or reporting associated with PBM oversight.
- Seven (7) years of professional experience in pharmacy at a health plan or PBM.
- Five (5) years of experience in triaging and resolving inquiries associated to claims and benefits.
- Seven (7) years of experience working Medicare Part D and/or Medicaid
- Previous experience in pharmacy technician role, with or without certification
- PBM experience preferred
- Bachelor's degree or equivalent experience
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Senior Pharmacy Benefit Manager Operations Analyst - Eagan, United States - Blue Cross Blue Shield of Minnesota
Description
About Blue CrossBlue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us.
How Is This Role Important to Our Work?
The PBM Operations Analyst Sr. will focus on establishing and refining operational processes related to CMS and State requirements for Medicare and Medicaid products. This position will develop an oversight structure of the Pharmacy Benefit Manager(s) (PBM), departmental and key stakeholder activities. This oversight structure will include the establishment of KPI's and program dashboards to measure performance.
A Day in the Life:
Required Skills and Experiences:
Nice to Have:
Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.
Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to
All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.
Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association.
