SENIOR THIRD PARTY ANALYST

Our Company

PharMerica

Overview

The Senior 3rd Party Analyst is a subject matter expert (SME) in claims processing, reimbursement, and other industry relations. This position is responsible for providing support, training, knowledge, and expertise to all levels of the organization in coordination with management directives and will ensure accuracy and integrity of junior analyst activities.

Responsibilities

• Serves as a functional knowledge resource for co-workers and other departments including new hire training and pharmacy education
• Assists in developing training documents as well as revising policies and procedures for the team and mentor/coach junior 3rd Party Analysts
• Monitors and audits junior analyst’s responses to pharmacy operations inquiries to ensure accuracy, completeness and thoroughness
  • Provides feedback for improved issue resolution
• Provides support and resolution to pharmacy operations inquiries. Work with pharmacy software system, claims processors, switch, store support, and IT to resolve escalated issues
• Participates as third party Subject Matter Expert on IT project teams for system enhancements that impact the processing of claims, including the development of business requirements, review and approval of documents, and conducting User Acceptance Testing
• Develops analytical reporting utilizing data warehouse tool. Analyze reporting to identify opportunities for process improvement, mitigation of third party rejections, and revenue recapture.  Effectively summarize and communicate analysis results
• Ensures communications impacting other areas of the company are distributed properly and timely
• Actively participates in industry organization meetings to represent the interests of the company and the long term care pharmacy perspective
• Assists supervisor with the direction of open items in the team’s email box and ticket system. Ensure requestors receive timely and accurate responses
• Provides input to supervisor and manager related to junior analysts’ training gaps, yearly reviews, and corrective action when necessary
• Collaborates regularly with Contracting, Purchasing, Claims Processing, Accounts Receivable, Cash Processing, Facility Billing, Admissions, Census, Plan Administration, IT, and other areas of the company
• Interacts and builds relationships with 3rd party entities including Pharmacy Benefit Managers (PBM’s), pharmacy claim switches, and other vendors
• Performs duties of junior analysts as needed
• Performs other tasks as assigned
• Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required.  Each essential function is required, although reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Qualifications

• HS Diploma, GED or equivalent experience; Associate or Bachelor’s degree, or relevant technical certification(s, preferred
• Pharmacy License
• Three or more years’ experience as a Pharmacy Technician or in a billing position within a healthcare setting
• Two or more years’ experience working in a Pharmacy, Long Term Care or Managed Care setting, and experience with pharmacy or health data analysis
• One or more year of internal or external auditing experience and experience training peers
• Excellent verbal and written communication skills
• Excellent time management skills
• Ability to work independently and manage multiple/competing priorities
• Proven ability to work with a high degree of accuracy and attention to detail
• Microsoft Office competency and fluency in Excel, application databases/software
• Ability to effectively navigate ambiguous situations with limited direction
• Advanced analytical aptitude with the ability to interpret and synthesize complex data sets and develop creative problem solving solutions
• Ability to handle high volume and significant workload
  • Query building experience through use of Microsoft Access or other proprietary systems
• Familiarity with long term care pharmacy or facility billing practices

About our Line of Business

PharMerica is a full-service pharmacy solution providing value beyond medication.  PharMerica is the long-term care pharmacy services provider of choice for senior living communities, skilled nursing facilities, public health organizations and post-acute care organizations.  PharMerica is one of the nation's largest pharmacy companies.  PharMerica offers unmatched employee development, exceptional company culture, seemingly endless opportunities for advancement and the highest hiring goals in decades.  For more information about PharMerica, please visit www.pharmerica.com.  Follow us on Facebook, Twitter, and LinkedIn.