Job details
Job type full-time
Full job description
Summary
This position is responsible for overseeing the government programs pharmacy benefit manager (pbm) performance as it relates to system releases, go-live benefit configuration accuracy, and claim adjudication accuracy.
The medicare/medicaid pharmacy senior analyst will provide quality assurance, project leadership, and oversight support of complex business processesThe incumbent will also be responsible for leading medium to large remediation projects, claim reprocessing oversight, pharmacy benefit management (pbm) system release testing and check out, data analysis, action plan tracking, and reportingThis position will be responsible for developing, implementing, and training for future audits and controls.
Primary responsibilities
Perform validation audits and monitors pbm`s performance on specific measuresThis will include working directly with the pbm at multiple levels to ensure that business needs are met.
Use various software applications, spreadsheets, relational databases, and statistical packages and graphics packages to assemble, manipulate, and format data.
Research and review complex cases to identify core needs and to resolve issues.
Report on the effectiveness of various pharmacy activities and departmental procedures, including identifying opportunities and recommendations.
Provide support to the department by creating, validating, analyzing, and maintaining various reports.
Develop new audits and controls for focus areas identified by managementThis will include designing, implementing, training, and performing the audits and controls.
Serve as subject matter experts relating to pharmacy operations, departmental goals, standards, policies, and procedures.
Develop powerpoint decks and present to audiences within and outside of the department.
Keep current on cms guidance, pharmacy benefits, and formularies.
Qualifications
Bachelor’s degree or equivalent work experience
Pharmacy technician certification preferred
Experience with medicare and/or medicaid required
Experience working with a pharmacy claims system strongly preferred
Excel experience required-intermediate level preferred
Knowledge of medicare regulatory requirements
Must be detail oriented, self-motivated, and have excellent organizational skills
Ability to adapt to changing environments and processes
Team oriented with strong written and verbal communication skills
Ability to meet deadlines and manage multiple priorities and effectively adapt and respond to complex fast-paced rapidly-growing and results oriented environment
Core competencies
Manages complexity
Manages ambiguity
Interpersonal savvy
Resourcefulness
This role is wah/flex which allows most work to be performed at homeEmployees must be fully vaccinated if they choose to come onsite.
This position is not eligible to be performed in colorado.
About cigna
Cigna corporation exists to improve livesWe are a global health service company dedicated to improving the health, well-being and peace of mind of those we serveTogether, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millionsThrough our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovationWhen you work with us, or one of our subsidiaries, you’ll enjoy meaningful career experiences that enrich people’s livesWhat difference will you make?
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: seeyourself@cigna.com for supportDo not email seeyourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.
