Transition Benefit Analyst - Remote Apply
Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make. Job Posting Title Transition Benefit Analyst - Remote Job Description The Transition Benefit Analyst is responsible for providing subject matter expertise to operational activities relating to Medicare Part D and Medicaid programs and formulary transition periods. This position is responsible for creating processes and standard operating procedures for transition activities, including formulary change transition mailing, tracking, letter creation, procedures, RxClaim transition rules and logic, and adjudication quality checks. All activities are subject to Centers for Medicare & Medicaid Services (CMS), client product requirements and Prime system requirements. Responsibilities Create, implement, and maintain processes to complete formulary change transitions; includes notifications, prior authorizations, tracking, client and business reporting, sign-off, quality checks, maintenance, and Standard Operating Procedure (SOP) development Implement new commercial clients for the transition product and work with them to create and modify Standard Operating Procedures around the different types of transitions Respond to client requests relating to formulary change and transition activities Participate in change management activities related to the Annual Formulary Change Transition mailing to all existing members Manage process to grandfather drugs for existing members, when required Coordinate formulary change transitions for new enrollees before and during the transition period Respond to requests for internal audits; assist in client and CMS audits relating to formulary change transition activities Provide subject matter expertise on all RxClaim logic necessary to support the transition product Other duties as assigned Minimum Qualifications Bachelors degree in Business Administration or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED required 2 years of work experience in benefits, claims or PBM operations Must be eligible to work in the United States without need for work visa or residency sponsorship Additional Qualifications Effective verbal and written communication and presentation skills Strong technical aptitude with an ability to be detail-oriented Demonstrated organizational skills Knowledge of drugs and drug categorization Intermediate Microsoft database skills Preferred Qualifications Previous managed care experience Medicare Part D program experience Extensive computer experience (RxClaim) and experience in computer programming Previous project management experience Minimum Physical Job Requirements Constantly required to sit, stand, use hands to handle or feel, talk and hear Frequently required to reach with hands and arms Occasionally required to walk and stoop, kneel, and crouch Occasionally required to lift and/or move up to 10 pounds Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus Reporting Structure Reports to Supervisor in the PBM Operations department Potential pay for this position ranges from $64,700.00 - $97,100.00 based on experience and skills. Pay range may vary by 8% depending on applicant location. To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page (https://www.primetherapeutics.com/careers/benefits/) and click on the \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\"Benefits at a glance\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\" button for more detail. Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law. Positions will be posted for a minimum of five consecutive workdays. Prime Therapeutics' fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members. If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people's lives. Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.866.469.1257 or email Careers@primetherapeutics.com.
