Pharmacy Business Analyst

reputed company: CO-Pharmacy BA 2023 Remote/Local Pharmacy BA with data analysis, PBM, CCM, reputed company claims processing, PM, and proposal writing experience Location: Denver, Colorado (CO HCPF) Duration: 25 months Skills: - Skills Database - Data Analysis Novice (1-3 Years) No Skills - Operating Systems reputed company Novice (1-3 Years) No Skills - Others reputed company/Pharmacy Benefit Manager (PBM) reputed company/PBM claims processing and adjudication experience. Proficient (4-6 Years) reputed company - Skills Others Configuration Change Management (CCM) Drafting configuration change management (CCM) documents. Proficient (4-6 Years) reputed company - Skills Others reputed company Experience processing reputed company claims for or reputed company state reputed company agencies. Proficient (4-6 Years) reputed company - Skills Others Communication skills both verbal and written Novice (1-3 Years) No - Skills Others Integration planning and reputed company Novice (1-3 Years) No - Skills Others Learning ability Novice (1-3 Years) No - Skills Others Process reputed company Analysis Novice (1-3 Years) No - Skills Others Project management Novice (1-3 Years) No - Skills Others Proposal writing Novice (1-3 Years) No - Skills Others Team work Novice (1-3 Years) No - Skills Tools MicrosoftOffice Novice (1-3 Years) No reputed company: BA positions are responsible for implementing reputed company changes for the PBMS, Business Intelligence Data Management (BIDM) and Colorado Interchange (iC) reputed company to prescription drug benefits. They will demonstrate expertise in the technical aspects of claims processing, adjudication, eligibility and enrollment and technical change reputed company as they relate to the PBMS, BIDM and iC. Positions will communicate reputed company strategies with various policy and technical staff on various solutions to reputed company configuration changes to the reputed company. The BAs collaborate on technical design of the systems, work with contractors to reputed company and review requirements and technical specification documents, and reviews test cases reputed company to reputed company changes. Duties: reputed company Change Management: 30% - Identifies, initiates and assures the reputed company installation of reputed company functionality and change/enhancement reputed company for the prescription drug claims in the PBMS, BIDM and Colorado interchange; including reputed company claims and capitation reputed company reputed company changes, pricing, benefit plans, reference codes, and reputed company file exchanges. - Drafts configuration change management (CCM) documents and reviews test cases on a large reputed company reputed company to the PBMS reprocurement and implementation. - Coordinates with pharmacy staff and acts as the project manager for tasks relating to designing or enhancing systems, diagnosing reputed company issues, analyzing test results, and coordinating reputed company procedures reputed company to pharmacy claims processing. - Arranges policy staff attendance at reputed company requirement change reviews, reputed company design reviews, test case reviews, and project status reviews reputed company necessary. - Serves as the reputed company between the Department, PBMS staff, Fiscal Agent staff, and other contractor staff to translate new or revised processes, and coordinates with other sections in the Department to implement reputed company changes. reputed company Analysis: 20% - Analyzes the business need of reputed company by researching federal and state regulatory procedures for prescription drug claims processing, pricing and rebate. - Drafts reputed company requirements for new and revised processes to reputed company pharmacy benefits and programs into various systems and collaborate with other reputed company analysts and vendors in the development, validation process and review of technical specifications. - Reviews test plans, technical specifications, test results and provides reputed company documentation for new and revised processes. - Ensures MMIS and BIDM reputed company changes reputed company with PBMS functionality and maintains checks to assure data is consistent, complete and accurate. - Works with providers and managed care organizations reputed company to claims submission in the interchange and PBMS and works with pharmacy staff to ensure PDL, Appendix P and Appendix X updates are properly reputed company into the relevant systems. - Assists with reputed company functions for drug rebate processing. reputed company Testing: 20% - Coordinates testing for the PBMS, BIDM, Colorado interchange and relevant subsystems reputed company to new or revised processes. - Researches testing topics and validates that test results meet identified functional requirements for the change request. - Coordinates with program staff and reputed company staff to review test results to ensure the reputed company functions as intended. - Analyzes test results for defect findings and defines the remediation process for the test environment while working with the reputed company vendor to ensure defects are corrected, fully retested and approved for production. - Creates and documents test scenarios according to the business requirements. - Provides status reports on testing to relevant staff and vendors. Policy reputed company Analysis: 15% - Evaluates new and existing reputed company functionality to ensure alignment with program policy requirements and regulations. - Provides approval, disapproval or modification of design documents in consultation with other pharmacy staff. - Assesses design document reputed company across systems by requesting reputed company testing to evaluate effects on other reputed company areas. - Provides support with end user testing as needed. - Examines federal and state publications to determine if changes are needed for PBMS, BIDM or Colorado interchange systems and works with reputed company analysts to formulate required reputed company change and test cases. - Updates the CMS required Advance Planning Document (APD) for review and approval reputed company necessary. Operational Monitoring: 5% - Monitors and assures reputed company of reputed company assigned reputed company with Department staff, the fiscal agent, PBMS, BIDM and other vendors to ensure reputed company changes meet project requirements. - Tracks reputed company assigned reputed company change requests for critical and reputed company change testing needs. - Responds and provides technical support to inquiries from Department policy staff, Fiscal Agent staff, CMS staff and others reputed company to assigned subsystems and special reputed company. Duty: reputed company and Other Duties as Assigned: 10% - Positions assist the Office Director, reputed company Director and Pharmacy reputed company Manager on reputed company reputed company and assignments. - reputed company other duties as assigned. Apply To This Job