Job Location : Newtown Square,PA, USA
PerformRx ;is a Pharmacy Benefits Manager (PBM) dedicated to clinical culture, boutique service, and holistic solutions. Our mission is to help clients, providers, and members use effective medication therapy to improve health and wellness. For over two decades, our focus has been on providing optimal service through a clinical culture that seeks to provide members with high-quality care while ensuring our partners receive favorable costs. That culture is reflected in our employees - more than 80 percent of our staff members are Pharmacists and Pharmacy Technicians - and in the services we provide.
PerformRx ;is headquartered in Philadelphia. Our dedication to innovation and to providing the most efficacious outcomes is the core of our clinical culture and is the heart of PerformRx. PerformRx is a subsidiary of the AmeriHealth Caritas Family of Companies. ;
Role Overview :
The Business Systems Analyst II will analyze business requirements related to Pharmacy technical deliverables and direct the testing, implementation, and support of said deliverables to meet contractual service level agreements (SLAs) while continuously improving processes.
Work Arrangement: Remote
Responsibilities :
Engage as the technical point-of-contact on pharmacy data and EDI (Electronic Data Interchange) deliverables, particularly Eligibility, Prescription Drug Event (PDE), Encounter, Claims, User Access, File Transfers, and connectivity, during new implementations and operational support
Work closely with business stakeholders to build and analyze business and functional requirements as relates to application and data systems
Define scope of the project and develop implementation strategies and project plans for development, testing, and implementation while tracking dependencies
Define test conditions and develop accurate and complete testing scenarios prior to implementation of new or updated technical deliverables
Coordinate activities with all departments and technical personnel as required for the rollout of new implementations
Maintain expert knowledge of business processes specific to direction, structure, and requirements, and identify deficiencies and recommend system improvements
Assess operational impacts related to project in regards to data integrity, data workflow, and address accordingly as required for successful implementation
Troubleshoot implementation and operational issues related to EDI deliverables (eligibility, claims, PDE, Encounters, User access) and work with vendor and/or Developers for resolution
Education/Experience:
Bachelor's Degree or an equivalent combination of education and work experience required
Requires:;
Minimum three (3) years ;of progressively more responsible related work experience, necessary in order to gain understanding of application data systems, operations, quality assurance processes, and business analysis skills
Minimum five (5) years of experience with industry (Pharmacy preferred) payer file exchange inclusive of Medicare, Medicaid, Commercial and compliance requirements
Project coordination experience;
Problem-solving skills and the ability to understand how various issues affect each other and the outcome of projects
Must possess analytical ability required to perform data analysis, reconcile defects, and recommend solutions
Payer Claims lifecycle knowledge and/or experience is a plus
Skills & Abilities:;
Your career starts now. We're looking for the next generation of healthcare leaders.
At AmeriHealth Caritas, we're passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in healthcare solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together, we can build healthier communities. If you want to make a difference, we'd like to hear from you.
Headquartered in Newtown Square, Pennsylvania, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.
Discover more about us at www.amerihealthcaritas.com
Our Comprehensive Benefits Package
Flexible work solutions include remote options, hybrid work schedules, competitive pay, Paid Time Off (PTO), including holidays and volunteer events, health insurance coverage for you and your dependents on Day 1, 401(k), tuition reimbursement, and more.
As a company, we support internal diversity through:
Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.