Responsible for internal and external functions that support data evaluation and throughout the year rebate payment submissions.
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
- Analyze PBM prescription claim and other applicable systems for monthly, quarterly and annual rebate payment submission
- Support internal and external customers with information on rebate payments and rebate agreements to medication claims and other data analysis for Rx and Medical drug claims.
- Communicate recommendations in regard to rebate data analysis.
- Analyze and create reports of PBM prescription claims and medical drug 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
- Participate in quality initiatives; including functions that support audits, reporting, evaluation of quality opportunities and concerns, and create and implement corrective actions as requested.
LEVEL 2 – PERFORMS JOB FUNCTIONS WITH MINIMAL SUPERVISION
- Communicate issues identified within rebate agreements or PBM data effectively to team.
- Evaluate and negotiate potential rebate agreements for rebate payments, prepare rebate summaries for senior management review, work with legal to finalize agreements
- Strategize solutions for issue resolution and communicate plans to team.
- Provide written documentation for desk levels.
- Provide support to other team members when necessary
- Make recommendations based on data analysis and create executive reporting from data analysis
LEVEL 3 – PERFORMS JOB FUNCTIONS WITH MINIMAL SUPERVISON; ACTS AS SUBJECT MATTER EXPERT
- Primary liaison for Pharmacy Management for applicable vendor applications.
- Primary SME contact for various internal departments within BCBSAZ.
- Build reporting and analyze data for rebate recommendations to management.
- Build reporting and analyze drug data for Clinical Therapeutics department including executive reporting for operations, financials, PBM etc.
- Each progressive level includes the ability to perform the essential functions of any lower levels and mentor employees in those levels.
- 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.
BCBSAZ does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.