Pharmacy Management Analyst

This role is responsible for conducting the drug claim review process including manual drug review, reporting, interaction with payers and providers, drug claim holds and rejects, and automated drug review rules development and maintenance.

 

Performs daily drug and miscellaneous code claim review and assists in resolving related issues, performing related reports, and conducting routine claim rejection process.  Accesses internal and external databases and sources to obtain needed information.  Tracks special client needs related to drug review and updates this information in a timely and accurate manner to meet contractual obligations.  Monitors the Pharmacy and Drug Review Incidents and facilitates the resolution of incidents related to drug and miscellaneous code claim review.

 

Maintains automated drug review rules

* Configures and maintains automated drug review rules, updating as necessary

* Identifies opportunities for system modifications to bring greater accuracy and efficiency

 

Responds to and initiates contact with internal and external stakeholders to clarify and gather needed information to ensure accurate and timely issue resolution.  Writes policies and procedures related to drug and miscellaneous code claims review to document departmental information surrounding the processes.  Participates in audit activities to ensure accuracy of processes. 

 

Education and Experience:

Bachelors Degree and 2+ years experience in Pharmacy, Home Health Care, Home Infusion or Pharmacy Benefit Management; or a combination of education and experience providing equivalent knowledge.   Equipment/Software Used: Microsoft Office (Word, Excel) and Outlook.

 

Key Competencies

· Knowledge of Pharmaceuticals, Infusion Products, and Medical Terminology.

· Knowledge of HCPCS Level II Coding.

· Written and verbal communication skills to initiate professional and effective contact with internal and external customers.

· Ability to work independently and manage multiple projects.  Strong time management skills.

· Ability to communicate effectively with internal and external stakeholders.

· Ability to make timely and sound decisions based on adequate information.

· Ability to identify and use appropriate resources and knowledge to resolve an issue.

· Ability to identify, document, and implement effective processes and procedures for accomplishing work.

· Good verbal, written, and problem solving skills. Proficiency in mathematics and metric conversion.

 

Required Certificates, Licenses and Registrations

Pharmacy Technician Certification or at least 2 years of equivalent experience.

 

 

ACM offers competitive compensation and excellent benefits, and a high energy work environment that values employees.  ACM offers a full benefits package that includes medical, dental, vision, life, flexible spending plan, bonus opportunities and 401(k).