Jobs in Analyst

Responsible for assisting and supporting the Group Operational Readiness team in the project coordination, establishment, and delivery of programs including but not limited to 2022 and 2023 ASC Contracting. Top 3 Required Skills/Experience – The most important must-have skills. Include: • Advanced Microsoft Skills in Word and Sharepoint, along with intermediate skills in Excel and…

Identify and communicate business needs and translate business requirements into technical system and functional specifications. Support one or more moderately to highly complex business processes/systems for multiple business units. Participate in business short-term planning sessions to ensure understanding of business goals, direction and business requirements; provide input from an IT systems perspective. Serve as a…

Engagement Description – This position requires the ability to multitask within a high-volume concierge contact center setting. Top 3 Required Skills/Experience – • Ability to process Coverage Determination Requests within CMS Timeframes • Ability to communicate all pharmacy benefits both verbally and written • Ability to have strong attention to detail while multitasking within a…

Support providers (pharmacists and physicians) with Commercial pharmacy/ specialty drug benefits analysis, drug coverage inquiries and prior authorization ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned. Answer telephones in an efficient and timely manner to lend appropriate assistance to providers Triage prior authorization requests under the supervision of a Clinical Pharmacist.…

Engagement Description – This position requires the ability to multitask within a high-volume concierge contact center setting. Top 3 Required Skills/Experience – • Ability to process Coverage Determination Requests within CMS Timeframes • Ability to communicate all pharmacy benefits both verbally and written • Ability to have strong attention to detail while multitasking within a…

Engagement Description – This position requires the ability to multitask within a high-volume concierge contact center setting. Top 3 Required Skills/Experience – • Ability to process Coverage Determination Requests within CMS Timeframes • Ability to communicate all pharmacy benefits both verbally and written • Ability to have strong attention to detail while multitasking within a…

Perform functions to include but not limited to business and systems analysis, application development and process improvement. Serve as a liaison between the business area and the IT organization when needed. Identify, document and communicate system and process changes necessary to improve system and operational performance measures. Possess an indepth knowledge of line of business…

Serve as a liaison between the business areas and the IT organization to provide technical solutions required for the achievement of business goals. Collect, analyze, develop, document, and communicate business requirement. Support several moderately complex business processes within one or more business functions. Bachelor’s degree in related field preferred. Three (3) year of relevant technical…

Engagement Description – This position requires the ability to multitask within a high-volume concierge contact center setting. Top 3 Required Skills/Experience – • Ability to process Coverage Determination Requests within CMS Timeframes • Ability to communicate all pharmacy benefits both verbally and written • Ability to have strong attention to detail while multitasking within a…

Engagement Description – This position requires the ability to multitask within a high-volume concierge contact center setting. Top 3 Required Skills/Experience – • Ability to process Coverage Determination Requests within CMS Timeframes • Ability to communicate all pharmacy benefits both verbally and written • Ability to have strong attention to detail while multitasking within a…

Other Skills: 4 Key required skills: • Extensive claims and benefits experience is required (NPS). • Extensive Analysis and Design experience including process flow development in Visio. • Healthcare industry experience is required. • Ability to handle multiple projects concurrently. • Reminder: When submitting candidates please include a response to the questions listed below. •…

Engagement Description – PA Specialist in Pt B Pharmacy will support providers (physicians and other healthcare providers rendering medical care) with Medicare Part B drug coverage inquiries, and prior authorizations. Top 3 Required Skills/Experience – • 2-4 years Specialty and/or Retail Pharmacy • Experience in provider/member call center or helpdesk • Process prior authorization requests…

Engagement Description – Support the Data Governance Office team in preparation and execution of the Data Exchange Attestation cycle. Carry out activities such as preparation of materials, reports, data extracts, load files. Assist team with user testing and validation of changes to attestation tool (MetricStream). Top 3 Required Skills/Experience – • Data analysis using Excel/MS…

Engagement Description – Service Operations is in need of a dedicated compliance liaison to support monitoring compliance with Center for Medicaid and Medicare Services (CMS), Patient Protection and Affordable Care Act (PPACA), National Committee for Quality Assurance (NCQA) accreditation, Health Information Trust Alliance (HITRUST), state mandates, Member Touchpoint Measures (MTM), regulations, and for ensuring that…