Business Analyst (Medicaid and PBM Domain) - Remote

Remote • Posted 60+ days ago • Updated 1 hour ago
Contract W2
Contract Independent
Contract Corp To Corp
12 Months
Remote
Depends on Experience
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Fitment

Dice Job Match Score™

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Job Details

Skills

  • CLAIMS PROCESSING
  • PHARMA
  • PHARMACY
  • PHARMACEUTICAL
  • BENEFIT MANAGEMENT
  • PBM
  • DRUG
  • CLINICAL
  • MEDICAID
  • CMS
  • MEDISPAN
  • SQL
  • AGILE

Summary

EXPERIENCE LEVEL:

  • Ideally 10+ years experience working in PBM domain (Claims processing related).
  • Willing to consider less experienced candidates who can demonstrate depth in understanding PBM area.

PBM SUBJECT MATTER EXPERTISE:

  • Candidate should have deep understanding of Pharmacy Benefit Management (PBM) business processes – including Claims Adjudication, Data related processes (e.g. Eligibility data, Provider data, Drug data, Formulary data, Drug Utilization reviews) and their interconnections. Strong plus if candidate has experience with Electronic Prescriptions and Prior-Authorizations related standards.
  • Deep understanding of related PBM standards from NCPDP. Strong plus if candidate also understands CMS regulations related to state Medicaid Pharmacy programs.
  • Candidate should have deep understanding of Financial Bank (FDB) Drug nomenclature and how to use FDB nomenclature in designing / configuring drug coverage (inclusions/exclusions/PA Criteria) or building Formulary / Preferred Drug Lists. In lieu of FDB, MEDISPAN data experience will be acceptable.
  • Candidate should be well informed about current industry trends and evolving standards.
  • College degree is preferred. Industry experience can be considered as substitute.
  • Candidates who have strong Clinical background (e.g. Pharmacists) and some BA background are welcome to apply (provided they are willing to switch to being a full-fledged BA with inhouse training)

 

Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.
  • Dice Id: 91139083
  • Position Id: 26-00637
  • Posted 30+ days ago

Company Info

About The Dignify Solutions, LLC

 The Dignify Solutions with Global Capabilities and Local Excellence – has combined experience of 30 +years in Client Services/ Engagement/ Relationship/ Partnership, Sales/ Account Management, Service Delivery, Recruiting, Staffing and Talent Acquisition for the whole gamut of skillsets in Information Technology (Digital Transformation, Artificial Intelligence, Machine Learning and other business domains).

The Dignify is dedicated to meeting the needs of two types of customers: our Clients and our Consultants. We ensure that our clients receive Top Talent while also allowing our consultants to accomplish their Professional Goals. 

The Dignify honors & prioritizes the Philosophy of Client Centricity and Delivery Excellence. The Dignify has dedicated Sales and Delivery Teams with each client, to make sure our standards and yours are being met. From Banking and Financial Services, Manufacturing and Retail, Energy and Utilities, Communication and Media, Technology and Telecom Services and beyond, our goal is to maintain a High Quality, Customer-Focused Engagement Model.

We are driven by three core principles in changing Staff Augmentation for the better: Cost, Quality, and Responsiveness. Whatever your need – be it a single resource or a whole team, we will find you the right talent in a timely and cost-effective manner.

The Dignify offers the Best Skilled Potential Talent, Services and Solutions to help our clients, accomplish their goals. As Market Intelligence Leaders, we provide insight into industry factors that will give you the competitive advantage you need to stay a step ahead of others in your space.

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