1224 IT & Software Developer jobs in the US
Pharmacy Benefits Management Senior Analyst
$90,000 - 120,000
Aroha Technologies
Ridgedale Avenue, Florham Park
$90,000 - 120,000
Requirements
Must:
- 10+ years of experience in the Pharmacy Benefits Management (PBM) domain, particularly in claims processing
- Deep knowledge of Pharmacy Benefit Management processes including claims adjudication, data handling (eligibility, provider, drug, formulary), and their interrelations
- Familiarity with electronic prescriptions and prior authorizations is advantageous
- Strong understanding of NCPDP standards related to PBM
- Knowledge of CMS regulations related to state Medicaid Pharmacy programs is a plus
- Proficient in First Data Bank (FDB) drug nomenclature and its application in designing drug coverage and formulary
- Experience with MEDISPAN data will also be accepted in lieu of FDB
- Awareness of current industry trends and evolving standards in PBM
- A college degree is preferred, but industry experience can be a substitute
- Clinical background, particularly as a pharmacist, with some business analyst experience is welcome
- Understanding of the Software Development Life Cycle and requirements management is essential
- Proficiency in utilizing tools like Visio, PowerPoint, Excel, and Word for documenting business processes and synthesizing requirements
- Experience with SQL queries and data models is a strong advantage
Responsibilities
- Provide PBM subject matter expertise to both Conduents development and testing teams, as well as external stakeholders
- Take charge of creating specifications and design documentation, including wireframes and decision tables, to assist developers in generating technical specifications
- Responsible for configuring drug plan benefits, including covered drugs, pricing configurations, and prior authorization requirements using the Conduent PBM system
- Engage with business and clinical users to gather and comprehend business needs
- Translate these requirements into formats suitable for the development and testing teams
- Knowledgeable in creating process workflows, use cases, PowerPoint presentations, and wireframes using Microsoft Visio
- Analyze data using Microsoft Excel to enhance requirements management and simplify the translation of requirements
- Document product features and requirements, preparing roadmaps with tools such as Visio and PowerPoint
Description
We are excited to expand our team with a Senior Business Analyst in a managerial or individual contributor capacity, depending on your experience. Our ideal candidate will possess extensive knowledge of the Pharmacy Benefits Management (PBM) industry and play a pivotal role in shaping the roadmap and feature enhancements of the Conduent PBM product suite. This position acts as a liaison between business users, clinical end users like pharmacists, and our technical teams. We foster a collaborative environment and offer opportunities for professional growth within our innovative company.
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You can find Business Specialist salaries in the United States here.
How many Business Specialist jobs are in the United States?
Currently, there are 1224 Business openings. Check also: Project-Manager jobs, Product-Manager jobs, CRM jobs - all with salary brackets.
Is the US a good place for Business Specialists?
The US is one of the best countries to work as a Business Specialist. It has a vibrant startup community, growing tech hubs and, most important: lots of interesting jobs for people who work in tech.
Which companies are hiring for Business Specialist jobs in the United States?
micro1, Groupe Québeco, Combat Computers Inc., Consultation Devpresso Inc, Surpass Solutions Inc, Lauserco Inc., Tactable among others, are currently hiring for Business roles in the United States.
The company with most openings is Kforce Technology Staffing as they are hiring for 72 different Business Specialist jobs in the United States. They are probably quite committed to find good Business Specialists.
The company with most openings is Kforce Technology Staffing as they are hiring for 72 different Business Specialist jobs in the United States. They are probably quite committed to find good Business Specialists.