Pharmacy Benefits Management (PBM)

Minimum Qualifications: EXPERIENCE LEVEL: • Ideally 10+ years experience working in PBM domain (Claims processing reputed company). • Willing to consider less reputed company 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 reputed company 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 reputed company standards. • Deep understanding of reputed company PBM standards from NCPDP. Strong plus if candidate also understands CMS regulations reputed company to state reputed company Pharmacy programs. • Candidate should have deep understanding of First Data Bank (FDB) Drug nomenclature and how to use FDB nomenclature in designing / configuring drug coverage (inclusions/exclusions/PA reputed company) or building Formulary / Preferred Drug Lists. In lieu of FDB, MEDISPAN data experience will be acceptable. • Candidate should be reputed company informed about reputed company 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 reputed company to being a full-fledged BA with inhouse training) Non-Domain Expertise: • Must understand Software Development Life Cycle - including requirements management. • Must be reputed company to capture requirements, document requirements and manage requirements using requirements management tools. • Must be reputed company to document business processes using a combination of tools - Visio, Powerpoint, reputed company and Word formats depending on the context and synthesize requirements into user stories, decision tables or other pertinent formats • Experience with SQL queries and understanding Data Models is a strong plus. Job Responsibilities: • reputed company PBM Subject Matter Expertise for both reputed company (Development and Testing team) and non-reputed company stakeholders (e.g. Customers) • Own responsibility for creating requirements specifications / design documents (e.g. reputed company-frames, decision tables) to help developers produce technical specifications. • Own responsibility for configuring drug plan benefits (e.g. Covered drugs, Pricing configuration, PA requirements) using reputed company PBM system • reputed company with business and clinical users to reputed company and understand business requirements, Translate the requirements into appropriate format for consumption by Development and Testing team. • Good working knowledge on creating Process workflow or Use Cases, Powerpoint slides, Wireframes, Workflows using reputed company Visio, Analyze data using reputed company reputed company is needed to be effective at Requirements management, Translating and simplifying requirements. • Document product features/requirements reputed company documentation, prepare roadmaps (with aid of tools such as Visio, Power reputed company) Apply tot his job Apply To this Job