Description and Requirements The Pharmacy Benefits Analyst is a dynamic role, responsible for oversight of the administration of the pharmacy benefit for all Medicare plans. The Pharmacy Benefit Analyst, under direction of the Sr. Manager of Medicare Pharmacy, will support Medicare initiatives, manage PDE resolution, monitor Medicare pharmacy benefits and PBM delegated activities, partner with the PBM, and maintain compliance with all Federal and State agencies.

Duties & Responsibilities:

Identifies opportunities for improvement and participates in the development of new pharmacy reporting capabilities to maximize performanceSupports operations, member experience, and FWA initiatives in collaboration with the Pharmacy Operations teamCollaborates with Medicare product team to identify and implement benefit solutions to promote quality and achieve cost savingsParticipates in the setup and monitoring of Medicare Pharmacy benefits and PDE accuracy in collaboration with out Pharmacy Benefit Manager (PBM)Monitors and analyzes key data and procedures for proper claims processing and adjudication system functionalityPerforms Quality Control and Quality Assurance functions to assess information accuracy prior to report distributionPartners with Enrollment and Billing to establish processes to reconcile enrollment and eligibility data used to effectuate appropriate access to prescription drug benefitProvides timely support to other areas to verify and analyze claims processing cases, eligibility and other operational situations and/or issues as they relate to delegated functionsReviews CMS communications related to Medicare Part D and leads implementation/response planningActs as HF’s Pharmacy PDE Subject Matter Expert (SME)Manages weekly CMS PDE reports to:Facilitate PDE resolutionAnalyze PDE reporting to ensure accuracy

Manages any new PDE and claims processes related to Medicare policy updates, audit findings, and benefits changesParticipates in and supports the annual Medicare bid and Go-To Market projects in collaboration with the Medicare Pharmacy teamManages primarily internal projects between Pharmacy and other HF business units, including Enrollment and Billing, IT, Enterprise Analytics, Regulatory, Population HealthTrack projects to targetCoordinate meetings with and collect deliverables from appropriate teamsCapture action stepsCommunicate to leadership

Performs regulatory monitoring Medicare Pharmacy benefits operationsMaintain compliance with all State and Federal agenciesAdditional duties as assigned

Minimum Qualifications: 

High school diploma or GEDPC Skills with Microsoft Word, PowerPoint (creating presentations and slides), and Excel (Pivot tables), MS AccessBasic SQL skills; able to build simple queriesExperience working with a Pharmacy Benefit Manager (PBM) within a health plan or direct experience at a PBM that includes client facing interactionAbility to communicate clearly both verbally and in writingDemonstrated critical thinking and problem-solving skillsAbility to lead large and small working meetingsPassion for learning, promoting access to healthcare, and interest in growing skills in a dynamic environment with various opportunities

Preferred Qualifications: 

Bachelor’s Degree or 3-5 years of managed care experienceKnowledge of PBMCertified pharmacy technicianKnowledge of regulations of the Centers for Medicare and Medicaid Services and the New York State Department of HealthKnowledge of Prescription Drug Events (PDEs) and billing practices in the medical and pharmacy benefitsExperience with pharmacy benefit management oversight including maintaining policies and proceduresPharmacy benefits installation and testing experience

Regulatory or Compliance activities: 

Assists in regulatory and compliance audits for all plans. Ensure all activities are conducted in compliance with regulations.

Hiring Range*:

Greater New York City Area (NY, NJ, CT residents): $67,200 - $97,155

All Other Locations (within approved locations): $59,800 - $88,910

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.