What are the responsibilities and job description for the Prescription Plan Design and Escalations Analyst 1-4 position at Apolis?
Job Details
LEVEL 1 PERFORMS JOB FUNCTIONS UNDER CLOSE SUPERVISION OR PEER REVIEW
" Analyze PBM prescription claim and other applicable systems for medication benefit quality and accuracy
" Support internal and external customers with information on benefits applicable to medication claims
" Perform, evaluate, and assist in defining and improving the quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines.
" Administer, interpret, and maintain current working knowledge of required BCBSAZ systems, procedures, forms and manuals
" Communicate recommendations in regard to medication claim processing and benefit decisions.
" Monitor and investigate reported plan set up system issues
" Participates in quality initiatives; including functions that support audits, reporting, evaluation of quality opportunities and concerns, and creation and implementation of corrective actions as requested.
" Resolve escalated member issues
" Research & provide recommendations for accumulations issues
" Logs all benefit setup issues on error tracking reports
" Provide monthly updates on error resolutions and impact reports
LEVEL 2 PERFORMS JOB FUNCTIONS WITH MINIMAL SUPERVISION
" Communicates issues identified within vendor system effectively to team.
" Communicates issues identified within plan setup testing or another escalated research to team
" Strategizes solutions for issue resolution and communicates plans to team.
" Provides written documentation for desk levels.
" Provides support to other team members when necessary
" Review plan testing documents for minimal accuracy
LEVEL 3 PERFORMS JOB FUNCTIONS WITH MINIMAL SUPERVISON, ACTS AS SUBJECT MATTER EXPERT
" Primary liaison for Pharmacy Management for applicable benefit design questions
" Primary SME contact for various internal departments within BCBSAZ In regard to pharmacy plan setup and design
" Builds reporting and analyzes data for benefit recommendations to management.
" Review and determine pharmacy benefit setup upon renewal for all benefit plans
" Build and setup all new pharmacy benefits in the pharmacy system; including standard patient pays
" Submit drug code assignments to enrollment for all benefit plans Maintain pharmacy drug code matrix
LEVEL 4 LEAD PERFORMS JOB FUNCTIONS AS ASSIGNED AND ALLOCATES RESOURCES AND PROJECT PRIORITIZATION
" Perform quality checks and analysis on drug code setup from other analysts
" Review escalated plan testing questions for accuracy and make corrections as needed
" Setup all complex pharmacy benefit plan designs
" Setup all complex patient pays, and any other design element related to complex pharmacy benefits
" Works with Pharmacy Management Leadership team to identify project prioritization
" Allocates resources to ensure required work is accomplished within defined time frames
" Assigns Tasks to Analysts and Specialists as needed
ALL LEVELS
" Each progressive level includes the ability to perform the essential functions of any lower levels and mentor employees in those levels.
" Properly track all pharmacy benefit issues & concerns
" The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
" Perform all other duties as assigned.
" Intermediate PC proficiency with word processing, spreadsheets, and claims and imaging software (Level 1)
" Intermediate skill using office equipment, including copiers, fax machines, scanners and telephones (all Levels)
" Advanced PC proficiency, including spreadsheet and vendor application software (Levels 2 and 3)
" Analyze PBM prescription claim and other applicable systems for medication benefit quality and accuracy
" Support internal and external customers with information on benefits applicable to medication claims
" Perform, evaluate, and assist in defining and improving the quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines.
" Administer, interpret, and maintain current working knowledge of required BCBSAZ systems, procedures, forms and manuals
" Communicate recommendations in regard to medication claim processing and benefit decisions.
" Monitor and investigate reported plan set up system issues
" Participates in quality initiatives; including functions that support audits, reporting, evaluation of quality opportunities and concerns, and creation and implementation of corrective actions as requested.
" Resolve escalated member issues
" Research & provide recommendations for accumulations issues
" Logs all benefit setup issues on error tracking reports
" Provide monthly updates on error resolutions and impact reports
LEVEL 2 PERFORMS JOB FUNCTIONS WITH MINIMAL SUPERVISION
" Communicates issues identified within vendor system effectively to team.
" Communicates issues identified within plan setup testing or another escalated research to team
" Strategizes solutions for issue resolution and communicates plans to team.
" Provides written documentation for desk levels.
" Provides support to other team members when necessary
" Review plan testing documents for minimal accuracy
LEVEL 3 PERFORMS JOB FUNCTIONS WITH MINIMAL SUPERVISON, ACTS AS SUBJECT MATTER EXPERT
" Primary liaison for Pharmacy Management for applicable benefit design questions
" Primary SME contact for various internal departments within BCBSAZ In regard to pharmacy plan setup and design
" Builds reporting and analyzes data for benefit recommendations to management.
" Review and determine pharmacy benefit setup upon renewal for all benefit plans
" Build and setup all new pharmacy benefits in the pharmacy system; including standard patient pays
" Submit drug code assignments to enrollment for all benefit plans Maintain pharmacy drug code matrix
LEVEL 4 LEAD PERFORMS JOB FUNCTIONS AS ASSIGNED AND ALLOCATES RESOURCES AND PROJECT PRIORITIZATION
" Perform quality checks and analysis on drug code setup from other analysts
" Review escalated plan testing questions for accuracy and make corrections as needed
" Setup all complex pharmacy benefit plan designs
" Setup all complex patient pays, and any other design element related to complex pharmacy benefits
" Works with Pharmacy Management Leadership team to identify project prioritization
" Allocates resources to ensure required work is accomplished within defined time frames
" Assigns Tasks to Analysts and Specialists as needed
ALL LEVELS
" Each progressive level includes the ability to perform the essential functions of any lower levels and mentor employees in those levels.
" Properly track all pharmacy benefit issues & concerns
" The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
" Perform all other duties as assigned.
" Intermediate PC proficiency with word processing, spreadsheets, and claims and imaging software (Level 1)
" Intermediate skill using office equipment, including copiers, fax machines, scanners and telephones (all Levels)
" Advanced PC proficiency, including spreadsheet and vendor application software (Levels 2 and 3)
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Salary : $26