• Job Description

  Req#: R207640

  Thank you for considering a career at Bon Secours Mercy Health!

  S cheduled Weekly Hours:

  40

  Work Shift:

  Days (United States of America)

  Remote Position

  Primary Function/General Purpose of Position

  The Pharmacy Business & Performance Analyst will assist in administrating the pharmacy benefits program by maintaining the pharmacy benefit formulary, facilitating administrative appeals, auditing pharmacy benefit claims, and analyzing pharmacy benefits data. The Pharmacy Benefits Managed Care Analyst will have a variety of job responsibilities within the pharmacy benefits team that may encompass various activities.

  Essential Job Functions

  • Organizes and facilitate administrative appeals received from members and providers through the PBM

  • Works with benefits pharmacist to compose appeals cases, disseminate appeal requests to appeals committee members, collate responses from committee members, and deliver response letters to members and providers

  • Analyzes and audit pharmacy claims with a focus on but not limited to significant changes in drug cost, appropriate use of wellness program claims, and claims with inappropriate quantities and day supplies

  • Collaborates with operations and clinical pharmacy team to troubleshoot patient care issues and requests

  • Assists I&T and data users to understand vendor file layouts, develop data files, and establish new data file transmissions with vendors. Also help to facilitate change to existing file transfers when necessary

  • Assigned tasks may include administration of accumulators, data base management, data file transfers to and from vendors, creation and maintenance of drug pricing and formulary files with vendors, and reconciliation of rebates and drug claim discounts

  • Attends and participate in meetings with clients and business partners as needed.

  • Communicates with and educate existing health plan members, physician offices, or pharmacies via inbound and outbound calls including cost savings opportunities.

  This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation.

  Licensing/Certification

  CPT Certification provided by the National Health Career Association or Pharmacy Technician Certification Board (PTCB) certification and registration with State Board of Pharmacy (preferred)

  Education

  High School Diploma/GED

  Work Experience

  Minimum of 1-year experience in one of the following: Managed Care, Retail, Ambulatory, Outpatient, Hospital, Acute Care, or Home Infusion pharmacy (required)

  Minimum of 1-year experience with pharmacy financial or business analysis and/or system in a health plan or PBM (preferred)

  Minimum of 1-year experience in customer service and/or healthcare (preferred)

  Training

  Completion of ASHP/ACPE tech training program - or - pharmacy technician training via Armed Forces/Veterans Affairs - or respective state department approved career tech high school program (preferred)

  Skills

  • Knowledge of PBM benefits set up, claims processing, and related regulatory requirements. Electronic Medical Records (EMR)Prioritization

  • Computer skills – word processing, spreadsheets, PowerPoint®, drug databases (required)

    • MS Office (Excel) (required)

    • Dashboard design (preferred)

    • Knowledge/training in Microsoft Access (preferred)

  • Familiarity with various software, equipment, and technology necessary to provide pharmacy services

  • Knowledge of pharmacy services within acute and ambulatory care environments

  • Knowledge of laws and regulations regarding pharmacy and/or pharmacy benefits/managed care pharmacy

  • Performance Improvement

  • Attention to Detail

  • Customer Service

  • Problem Solving

  • Active Listening

  • Verbal and Written Communication

  • Professional Judgement

  • Telephone etiquette

  • Time, project, and change management

  • Working independently

  • Organization

  • Providing feedback

  Bon Secours M ercy Health is an equal opportunity employer.

  Many of our opportunities reward* your hard work with:

  • Comprehensive, affordable medical, dental and vision plans
  • Prescription drug coverage
  • Flexible spending accounts
  • Life insurance w/AD&D
  • Employer contributions to retirement savings plan when eligible
  • Paid time off
  • Educational Assistance
  • And much more

  *Benefits offerings vary according to employment status.

  Department:

  SS Pharmacy & Lab - Ambulatory Pharmacy

  It is our policy to abide by all Federal and State laws, as well as, the requirements of 41 CFR 60-1.4(a), 60-300.5(a) and 60-741.5(a). Accordingly, a ll applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you’d like to view a copy of the affirmative action plan or policy statement for Mercy Health– Youngstown, Ohio or Bon Secours – Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employer, please email recruitment@mercy.com. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at recruitment@mercy.com .

• About the company

  On September 1, 2018 Bon Secours Health System and Mercy Health combined to become the United States’ fifth largest Catholic health care ministry and one of the nation’s 20 largest health care systems. With 48 hospitals, thousands of providers, over 1,000 points of care and over 60,000 employees Bon Secours Mercy Health serves communities across seven states and Ireland.

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