SCOPE OF ROLE

The Sr. Analyst, Pharmacy Operations will provide operational support and oversight about the delegated function of the pharmacy benefit manager to ensure compliant administration of the health plan benefits. This role will develop a detailed understanding of all pharmacy benefits, delegated functions to downstream entities, and compliance requirements.  These accountabilities will be used to identify discrepancies with the administration or any regulatory concerns.

ROLE RESPONSIBILITIES

Core responsibilities will involve Medicare-specific pharmacy benefit administration and CMS requirements.  The job description below is intended to point out other responsibilities within the role, but it is not limited to these items.

• Enhance and execute the coordination of the benefits process for the recoupment of costs associated with all applicable claims.
• Develop a robust tracking tool around recoupment with the ability to report to senior leadership.
• Intake, manage, and resolve inquiries, issues, and audits that may come from members, stakeholders, states, CMS, and/or any other channel.
• Contribute to the preparation of dashboards and reports that will be used for oversight, management, and leadership reporting.
• Support the management of project plans, meeting minutes, and any applicable work files for PBM, internal stakeholders, or external vendor initiatives.
• Draft and maintain administrative pharmacy policies related to core job responsibilities.
• Collaboratively work with both clinical and non-clinical areas within Bright.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• Ten (10) years of professional experience in Pharmacy at a health plan or PBM.
• Five (5) years of experience in triaging and resolving inquiries associated with claims and benefits.
• Five (5) years of experience with Medicare.
• Five (5) years of project management/relationship management experience required, preferably in the pharmacy or healthcare industry preferred.

PROFESSIONAL COMPETENCIES

• 100% team player and ability to collaborate effectively with others to achieve common goals.
• Able to multi-task, set priorities, and demonstrate strong organization and problem-solving skills.
• Comfortable following timeline-driven work plans and managing multiple projects; thrive in collaborative environments.
• Self-starter that can develop and execute a plan to address ambiguous situations or ones with limited direction.
• Familiarity with Excel and PowerPoint skills to create organized and actionable representations with minimal guidance.  
• Exceptional attention to detail.
• Excellent customer service and communication skills.
• Excellent written and verbal communication skills; ability to provide clear and concise information to senior leaders.

WORK ENVIRONMENT

• Remote