Pharmacy Process Expert II

Description

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care. 

This position will allow remote within a commutable distance to any Ingenio office:

Atlanta, GA / Chicago, IL / Las Vegas, NV / Louisville, KY / Mason, OH / Minnetonka, MN / Morristown, NY / St. Louis, MO / Virginia Beach, VA / Wallingford, CT

Assists in identifying and researching workflow problems and system irregularities.

Primary duties may include, but are not limited to:

Monitors reports/has oversight of Intake Site.

Reviews adjustment requests submitted to Intake site for accuracy and clarifies requests with the submitter as appropriate.

Receives guidance and mentoring from more experienced process experts.

Will help mentor Process Expert I after obtaining necessary training and experience.

Researches operations workflow problems and system irregularities; assists with the development and testing of process improvement solutions for new systems, new accounts and other operational improvements; assists with the development and leading of project plans and communicating project status.

Supports a single operations department by participating in project and process work.

Also working on configuration of the Pharmacy Prior Authorization processing system:

Primary focus will be assisting with the maintenance of letters under the guidance of communication experts.

Assists with the maintenance of Prior Authorization turnaround timers under the guidance of compliance experts.

Assists with maintaining security roles for PA associates.

Assist in UAT.

Assists with the development and testing of process improvement solutions for new systems, new accounts and other operational improvements.

Assists in identifying and researching workflow problems and system irregularities.

Monitors reports/has oversight of Prior Authorization communications Intake site.  

Qualifications

Requires a BA/BS degree

5-7 years experience in business analysis, process improvement, project coordination in a high-volume managed care operation (claims, customer service, enrollment and billing) with the ability to analyze workflows, processes, supporting systems and procedures and identifying improvements

Or any combination of education and experience, which would provide an equivalent background

For URAC accredited areas the following applies: Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills

Preferred Experience:

Must be extremely detailed oriented.

Pharmacy Prior Authorization or Pharmacy Operations experience.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.