Healthcare PBM Analyst required

Job Description Job Description My name is Martin and I'm a recruiter at Kyyba. I came across your resume and believe you are a great fit for my Health Care Analyst position based in Southfield, MI. I've included the job description here for your review. Please let me know if you'd like to discuss this opportunity in greater detail. Job Title: Healthcare PBM Analyst Location: Detroit, MI Duration: 12 Months Hybrid work role (1 day / week onsite) Medicare Pharmacy Operations Dept SUMMARY: The Healthcare Analyst position is responsible for assisting Medicare Advantage PPO, HMO and PDP plans meet CMS compliance requirements for PBM oversight, CMS reporting, review member eligibility and reporting, benefit set up 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 rate. RESPONSIBILITIES/TASKS: 1. Develops and improves work flows and business processes within area(s) to improve customer service, decrease operational costs, and improve overall quality. 2. Assists Customer Service with questions and clearly communicates responses to inquiries. 3. Assist in CMS and other data audits conducted by CMS and internal audit teams 4. Identifies and/or analyzes business problems and devise procedures for solutions to the problems. 5. Effectively leads projects in order to produce desired results. 6. Responsible for corporate communication of project results. 7. Recommends and assists with implementing standard policies and procedures. 8. Assures that corporate compliance is communicated, implemented, and monitored on an ongoing basis. 9. Participates in systems testing, develops procedures/controls, and provides recommendations for the ongoing improvement of the updated process. 10. Assists personnel (both internal and external) by answering questions, supplying information, and training. 11. Develops and maintains an effective working relationship with customers. 12. Participates in group or committee discussions. Education: Bachelor's degree in a related field is preferred. Relevant combination of education and experience may be considered in lieu of degree. Continuous learning, as defined by the Company's learning philosophy, is required. EXPERIENCE: Four (4) years' experience in a related field is required (prefer health plan or PBM). Experience with Microsoft Office applications including Excel, Word and Outlook. Must have data analysis, and problem resolution skills. Spreadsheet and/or Database skills. Experience resolving eligibility and pharmacy claims related issues. Experience with responding to CMS requests regarding pharmacy claims timely. SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED: 1. Knowledge of pharmacy claim processing and Medicare guidance related to Part D products. 2. Organizational skills and ability to prioritize; must be able to lead multiple activities with varying timelines. 3. Ability and willingness to learn and take on more responsibilities based on activities with the team. 4. Experience with PBM systems and tools. 5. Ability to understand questions from external areas and articulate timely and accurate responses. 6. Analyst experience required with proven experience in operational analysis, data analysis, and problem resolution type activities. 7. Analytical, organizational, planning and problem solving skills 8. Understanding and knowledge of the business, products, programs, corporate organizational structure (including functional responsibilities), and basic research principles/methodologies 9. Ability to plan, organize, direct, and control projects. 10. Excellent written and verbal communication skills. 11. Ability to lead and contribute to process improvement projects. 12. Ability to read and interpret documents such as data flows, process flows, technical diagrams, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization. 13. Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations. 14. Administer and adhere to corporate and departmental policies, practices and procedures. Company Description About Kyyba: Founded in 1998 and headquartered in Farmington Hills, MI, Kyyba has a global presence delivering high-quality resources and top-notch recruiting services, enabling businesses to effectively respond to organizational changes and technological advances. At Kyyba, the overall well-being of our employees and their families is important to us. We are proud of our work culture which embodies our core values; incorporating value, passion, excellence, empowerment, and happiness, creates a vibrant and productive atmosphere. We empower our employees with the resources, incentives, and flexibility that they need to support a healthy, balanced, and fulfilling career by providing many valuable benefits and a balanced compensation structure combined with career development. Company Description About Kyyba: Founded in 1998 and headquartered in Farmington Hills, MI, Kyyba has a global presence delivering high-quality resources and top-notch recruiting services, enabling businesses to effectively respond to organizational changes and technological advances. At Kyyba, the overall well-being of our employees and their families is important to us. We are proud of our work culture which embodies our core values; incorporating value, passion, excellence, empowerment, and happiness, creates a vibrant and productive atmosphere. We empower our employees with the resources, incentives, and flexibility that they need to support a healthy, balanced, and fulfilling career by providing many valuable benefits and a balanced compensation structure combined with career development.

Created: 2024-11-13