Business Analyst - P....
Business Analyst - Pharma
Posted on :
17-11-2022
Employer Active
1 Vacancy
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Job Description
Req ID : 1684348
Role: Business Analyst - Pharma
Location: Twinsburg, OH
Duration: Contract
Job Role: Business Analyst
Location: Twinsburg, OH
Duration: Long Term Contract JOB DESCRIPTION:
- Experience of 8+years in Healthcare Payer/PBM domain
- Demonstrated Working experience in Payer-PBM interfaces (few key entities from Pharmacy/PBM spectrum)
- Subrogation Claim Processing
- Member Eligibility
- Product/Benefit
- Claim Processing
- Prior Authorization
- Formulary
- Consumer/Member portals & Mobility applications
- Medicare/Medicaid, PDE, Encounter
- Coordination of Benefits
- NCPDP layout and EDI Rx transactions
- Specialty Pharmacy
- Mail-order Pharmacy
- Excellent knowledge in Elicitation of Business requirements by collaborating with Business sponsors
- Efficient in translating Business Requirements into Functional and Non-Functional Requirements
- Should have experience working in PBM Data processing projects
- Strong communication skillset who can be engaged with business stakeholders as Pharmacy domain SME
- Demonstrate Techno Functional understanding and hand-on experience with prior authorization, Claims and eligibility processing systems with Payer/PBM.
- Knowledge of claim adjudication principals Pharmacy Benefit Management experience is an asset
- Experienced in User Acceptance Testing ( UAT )
- Strong exposure to Agile and Waterfall - Model and tools (eg: JIRA, Confluence etc)
- Excellent interpersonal and communications skills
- Experience analysing and reporting on performance and utilization data
- Strong delivery and creation of presentations to leaders
- Good to have
- Working experience with Claims or Eligibility application or application modernization with any of the leading Payers/PBMs
- Certified in Agile practices - SAFe Practitioner, Scrum Master etc
- Certifications in Business Analysis
- Design and implement simple solutions in order to solve complex business problems
- Gather and document business requirements
- Actively participate in project team meetings and lead when necessary
- Define, recommend and build opportunities to automate existing systems processes
- Participant at regular Client Support meetings
- Mentor, coach and develop team members to achieve higher levels of performance and job mastery
- Implement operational or efficiency improvements to enhance current processes
- Collaborate within and/or across internal business units to develop and execute on initiatives/projects
- Develop and produce documentation and testing material to support client initiatives/implementations
Employment Type
Full Time
Key Skills
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