Pharmacy Operations Analyst
Randstad Healthcare is hiring Sr. Pharmacy Operations Analyst for a reputable facility. This will be a remote position, but you must be located in one of the following states:
North Carolina, Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming
JOB DESCRIPTION
- Works closely with other team members for the design and implementation of pharmacy benefits.
- Provides support on escalated and/or complex issues.
- Works closely with other team members on annual corporate project to refresh of individual and group pharmacy benefit offerings.
- Maintains project plan documents and provides periodic updates to management on a regular basis, meeting required project deadlines.
- Pharmacy operational lead for web updates
- Audits all prescription drug benefit plans built by Pharmacy Coordinators.; Audit includes benefits set up.
- Partners with internal business partners to meet our clients' needs.
- Support/Collaboration with internal business partners to ensure complete compliance with state and federal regulations for commercial plans. Monitors and facilitates resolution of compliance issues from an operational perspective and provide appropriately timed updates for upward dissemination.
- Engages with other staff members and client engagement teams in activities focused on client retention and new sales, and analysis and resolution of group or individual benefit issues identified by corporate business partners or through internal/external audit.
Responsible for all of the medicare side of the pharmacy business
Works to create and implement all pharmacy benefits - Medicare plans mainly.
Working with CMS guidelines and reporting for Medicare, monitoring CMS on state and federal levels.
Reporting requirements to CMS on deadlines to include creating the reports.
Benefit Uploads for PBM into the next year
Required experience
Need Medicare exp (Pharmacy + CMS) and reporting requirements
Strong Excel experience - working at the highest level in excel
Medicaid Pharmacy Claims experience is huge
Strong writing skills
Ability to see the fine details, look deeper into the information
Ability to work at a high volume and meet deadlines
Hiring Requirements
- Bachelor's degree or advanced degree (where required)
- 5+ years of experience in related field.
- In lieu of degree, 7+ years of experience in related field.
- must have experience with Medicare **
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.
At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact [email protected].
Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).
This posting is open for thirty (30) days.
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
Apply Now
Apply Now
North Carolina, Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming
JOB DESCRIPTION
- Works closely with other team members for the design and implementation of pharmacy benefits.
- Provides support on escalated and/or complex issues.
- Works closely with other team members on annual corporate project to refresh of individual and group pharmacy benefit offerings.
- Maintains project plan documents and provides periodic updates to management on a regular basis, meeting required project deadlines.
- Pharmacy operational lead for web updates
- Audits all prescription drug benefit plans built by Pharmacy Coordinators.; Audit includes benefits set up.
- Partners with internal business partners to meet our clients' needs.
- Support/Collaboration with internal business partners to ensure complete compliance with state and federal regulations for commercial plans. Monitors and facilitates resolution of compliance issues from an operational perspective and provide appropriately timed updates for upward dissemination.
- Engages with other staff members and client engagement teams in activities focused on client retention and new sales, and analysis and resolution of group or individual benefit issues identified by corporate business partners or through internal/external audit.
Responsible for all of the medicare side of the pharmacy business
Works to create and implement all pharmacy benefits - Medicare plans mainly.
Working with CMS guidelines and reporting for Medicare, monitoring CMS on state and federal levels.
Reporting requirements to CMS on deadlines to include creating the reports.
Benefit Uploads for PBM into the next year
Required experience
Need Medicare exp (Pharmacy + CMS) and reporting requirements
Strong Excel experience - working at the highest level in excel
Medicaid Pharmacy Claims experience is huge
Strong writing skills
Ability to see the fine details, look deeper into the information
Ability to work at a high volume and meet deadlines
Hiring Requirements
- Bachelor's degree or advanced degree (where required)
- 5+ years of experience in related field.
- In lieu of degree, 7+ years of experience in related field.
- must have experience with Medicare **
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.
At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact [email protected].
Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).
This posting is open for thirty (30) days.
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
Apply Now
Apply Now