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    Transition Benefit Analyst - Boise, United States - Idaho State Job Bank

    Idaho State Job Bank
    Idaho State Job Bank Boise, United States

    3 weeks ago

    Idaho State Job Bank background
    Description
    Transition Benefit Analyst
    • Remote at Prime Therapeutics in Boise, Idaho, United States Job Description Our work matters.
    We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make. Job Posting Title Transition Benefit Analyst
    • Remote Job Description The Transition Benefit Analyst is responsible for providing subject matter expertise to operational activities relating to Medicare Part D and Medicaid programs and formulary transition periods.
    This position is responsible for creating processes and standard operating procedures for transition activities, including formulary change transition mailing, tracking, letter creation, procedures, RxClaim transition rules and logic, and adjudication quality checks. All activities are subject to Centers for Medicare & Medicaid Services (CMS), client product requirements and Prime system requirements. Responsibilities + Create, implement, and maintain processes to complete formulary change transitions; includes notifications, prior authorizations, tracking, client and business reporting, sign-off, quality checks, maintenance, and Standard Operating Procedure (SOP) development + Implement new commercial clients for the transition product and work with them to create and modify Standard Operating Procedures around the different types of transitions + Respond to client requests relating to formulary change and transition activities + Participate in change management activities related to the Annual Formulary Change Transition mailing to all existing members + Manage process to grandfather drugs for existing members, when required + Coordinate formulary change transitions for new enrollees before and during the transition period + Respond to requests for internal audits; assist in client and CMS audits relating to formulary change transition activities + Provide subject matter expertise on all RxClaim logic necessary to support the transition product + Other duties as assigned ? Minimum Qualifications + Bachelor's degree in Business Administration or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED required + 2 years of work experience in benefits, claims or PBM operations + Must be eligible to work in the United States without need for work visa or residency sponsorship Additional Qualifications + Effective verbal and written communication and presentation skills + Strong technical aptitude with an ability to be detail-ori To view full details and how to apply, please login or create a Job Seeker account
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