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Pharmacy Analyst (Financial)

Company: SCAN Health Plan
Location: Long Beach
Posted on: November 26, 2022

Job Description:

SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation's leading not-for-profit Medicare Advantage plans, serving more than 270,000 members in California, Arizona, and Nevada. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org , www.scanhealthplan.com , or follow us on LinkedIn, Facebook, and Twitter.The JobThe Pharmacy Financial Analyst conducts daily operational oversight of the SCAN Pharmacy Benefit Management (PBM) company as it relates to Prescription Drug Events (PDE), Claims Adjustments and financial oversight. Serves as a subject matter expert on PDEs, DIR, End of Year PDE Reconciliation and pharmacy data analytics. Will support regulatory audits by compiling sample data, researching outliers and providing audit responses. Performs oversight of Medicare Plan Finder pricing accuracy and drive 5 Star performance for star measure. Conducts PBM contract performance management.You WillServe as a subject matter expert for MPF pricing accuracy star measure, data analytics, PDE requirements, PDE calculations and end of year PDE reconciliation.Perform oversight of the PBM specific to PBM contract, performance guarantees, and financial guarantees.Conduct operational oversight of PDE by managing PDE rejections and work with other SCAN business units and the PBM to resolve PDE errors. Track all PDE logic issues and work with the PBM to ensure the PDE logic is fixed, claims are adjusted and PDEs are resubmitted within CMS requirements. -Manage prescription claim and PDE files sent by the PBM to ensure accuracy of the data prior to upload into SCAN internal systems and data warehouse.Ensure PBM is processing PDE, prescription claims and prescription claim adjustments to CMS regulatory standards by conducting daily oversight. -Conduct finance data management, ad-hoc financial analyses, and support pharmacy financial close with production reporting. Will research and provide responses to financial inquiries related to CMS pass through costs.Perform Rebates/DIR/Discounts oversight monitoring.Analyze large data sets that are exchanged from SCAN to the PBM using a variety of reporting tools. Ensure audit documentation is prepared according to audit instructions and provided within the specified audit time frame. Prepare written responses or documentation for pharmacy audits.Provide assistance to internal and external customers at SCAN, by troubleshooting and problem solving pharmacy related questions pertaining to claims, DIR, PDE or PBM financial guarantees.Perform routine monitoring to ensure Part D compliance and detect performance issues or operational gaps. Provide corrective feedback and recommendations to staff or PBM and ensure follow through.Maintain professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.Other duties as assigned.Your QualificationsBachelor's degree in Business Administration, Statistics, Economics or related field preferred. -A comparable combination of education/experience and/or training will be considered equivalent to the education listed.5+ years of experience working in Pharmacy Managed Care required.3+ years of Medicare Part D experience required.Medicare Star Rating experience required.Regulatory audit experience is required.Expertise in mining healthcare data, including but not limited to, eligibility, encounters, pharmacy claims, industry drug databases, provider, and financial data.Expert knowledge of Part D CMS requirements as it relates to PDE calculations and end of year PDE reconciliation.Proficient with conducting financial data analytics.Strong interpersonal skills, including excellent written and communication skills.Excellent organizational, decision-making, and multi-tasking skills.Ability to prioritize workload to meet deadlines.Excellent grammar and writing skills.Excellent verbal skill sets to be able to communicate in conference calls and in large meetings.Self-starter that can take the lead on a project and manage its progress for completion.Detail oriented and is able to work with large data sets.Advanced skills with Microsoft Office 2016; e.g., Word, Excel, Access, SQL and PowerPoint.Proficient with Tableau.Excellent organizational capabilities with ability develop partnerships and strong working relationships within the organization and with the PBM.Ability to interact effectively and professionally with all levels of staff.To ensure a healthy and safe work environment, if you are selected for this position, your job offer with SCAN Health will be contingent upon being fully vaccinated and providing proof of your COVID-19 vaccine within 3 days after your start date. Generally, you are considered fully vaccinated 14 days after receiving the last dose, as recommended by the manufacturer, of a vaccine that has been authorized by the FDA for use in the United States, including vaccinations that have been approved pursuant to an Emergency Use Authorization. If fully vaccinated outside of the United States, the vaccination must be listed for emergency use by the World Health Organization (WHO). If you cannot receive the vaccine because of a disability/medical reason or sincerely-held religious belief, you may request an accommodation to this requirement by contacting COVID-19 Vaccination Policy . Learn more about the COVID-19 vaccination here - https://www.cdc.gov/coronavirus/2019-ncov/vaccines/index.html What's in it for you?

  • A competitive compensation and benefits program -
  • An annual employee bonus program
  • Robust Wellness Program
  • Generous paid-time-off (PTO)
  • Ten paid holidays per year, plus 1 additional floating holiday
  • Excellent 403(b) Retirement Saving Plan with employer match
  • Robust employee recognition program
  • An opportunity to become part of a team that makes a difference to our members and our community every day!We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.#LI-CS2Equal Opportunity Employer/Protected Veterans/Individuals with DisabilitiesThe contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)

Keywords: SCAN Health Plan, Long Beach , Pharmacy Analyst (Financial), Accounting, Auditing , Long Beach, California

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