Jobs in Analyst

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 – Individuals in the Systems Analysis job family are responsible for planning, developing, testing and implementing IT system solutions that improve business efficiency and productivity as well as support business strategies and goals. They identify and communicate business needs and translate business requirements into technical system and functional specifications. Systems Analysts determine if…

Engagement Description – Responsible for assisting Medicare Advantage PPO, HMO and PDP plans meet CMS compliance requirements for PBM oversight, claims processing, CMS reporting and benefit set up and testing. Job responsibilities include Perform a quality review of claims to ensure overall quality, Assist Customer Service with questions and clearly communicates responses to inquiries, participates…

Engagement Description – • Reviewing claim submissions and verifying claims processed correctly. • Auditing claims-making sure the system applied the correct benefits, pricing, and cost share values. o Comparing claims data to the members benefits and other policy documents. o Ensuring the system applied to correct allowed amounts using CMS fee schedules. o Confirmed system…

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 – Work with vendor risk assessment process and tools. Document the issues and risks that arise from the assessments. Work with contract admins and vendor contacts to solve for the issues and risks. Work with VRM team to improve and elevate the vendor risk program. Work across other functions like – procurement, business,…

Perform technology 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 as needed. Identify, document and communicate system and process changes necessary to improve system and operational performance measures. Possess an in-depth knowledge of line of…

The Senior Health Care Analyst is responsible for planning, organizing, directing, implementing, and leading department assignments. This position operates within broad objectives to ensure optimum utilization of manpower and budget. This role research, compiles, and analyzes appropriate and relevant data and makes recommendations for operational improvements. Top 3 Required Skills/Experience – • Minimum of five…

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…

Responsible for assisting and supporting management in the evaluation, recommendation, establishment, implementation and analysis of new and improved production workflows, work processes for systems, reporting and new products/programs to improve customer service levels and overall quality. • Support the development, coordination, and implementation of projects to enhance the overall efficiency of operational procedures, methods, controls,…

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. •…

The Senior Analyst position is responsible for assisting Medicare Advantage PPO, HMO, and PDP plans to meet CMS compliance requirements for PBM oversight, CMS reporting, and benefit setup and testing. Other related skills may be required to perform this job The maximum hourly rate reflects budget estimates only and does not reflect the final negotiated…

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 – Individuals in the Systems Analysis job family are responsible for planning, developing, testing and implementing IT system solutions that improve business efficiency and productivity as well as support business strategies and goals. They identify and communicate business needs and translate business requirements into technical system and functional specifications. Systems Analysts determine if…