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KDnuggets Home » Jobs » BC/BS of RI: Analyst - Medicare  ( 13:n15 )

Sr Contract Monitoring Analyst-Medicare Part D


Conduct pharmacy claim and data analyses to monitor Medicare Part D obligations, claim adjudication accuracy and ensure CMS requirements are being met, extract and analyze pharmacy claims.



Blue Cross Blue Shield of Rhode Island Company: Blue Cross Blue Shield of Rhode Island
Location: Providence, RI
Web: www.bcbsri.com

Summary

  • Conduct in-depth pharmacy claim and data analyses to monitor Medicare Part D Pharmacy Benefit Manager (PBM) contractual obligations, validate system configuration, claim adjudication accuracy and ensure CMS requirements are being met.
  • Extract and analyze pharmacy claims, formulary data and benefit information to monitor and ensure optimal adjudication results.
  • Measure performance guarantees as part of the overall assessment of contract performance.
  • Conduct annual rebate and brand/generic guarantee rate reconciliations.
  • Serve as subject matter expert and project lead on various PBM related initiatives.
  • Act as liaison between the business and applicable contract-related vendors to facilitate escalation of issues, problem resolution, system enhancements and project implementations.
Qualifications
  • Bachelor’s Degree in Business Management, Finance, Mathematics, Computer Science, Statistics or related field or an equivalent combination of education and work experience.
  • Five to seven years experience in quantitative business analyses and statistical modeling (preferably healthcare related).Proven analytical experience using Enterprise Guide SAS, database query capabilities and ability to evaluate data at various levels of detail (preferably Enterprise Guide SAS)
*Subject Matter Expert on Medicare Part D and CMS requirements and Pharmacy Benefit Manager (PBM) technical and operational experience is preferred


_Contact_:
Apply online for Sr Contract Monitoring Analyst-Medicare Part D , Job ID: 20131604-01431

or apply directly here.

BCBSRI is an equal opportunity employer committed to an inclusive and diverse workforce. EOE/AA.


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