Our client, one of the largest healthcare corporations, is looking for a Pharmacy Analyst to work Remotely in the US. The Pharmacy Analyst must have expertise in Medicare Part D claims processing and end-to-end business processes. As a key member of our Pharmacy Experience Team, you will handle complex Medicare Part D Pharmacy member inquiries, including complaints and grievances to play a crucial role in maintaining the integrity of Medicare Part D plan administration.

Pay Rate Range: $23.00 to $30.00 per hour / depending on experience

Schedule: Monday through Friday 9:00AM to 5:00PM CST

Location: Remote in the US

Duration: Position is a 8 month W2 contract role

RESPONSIBILITIES:

• Act as the primary resource for complex Medicare Part D plans, managing escalated pharmacy issues through direct communication via phone, email, or SharePoint.
• Develop a deep understanding of Medicare Part D products, CMS guidelines, and Pharmacy Benefit Manager (PBM) claim adjudication systems, translating this knowledge into practical solutions.
• Identify and address unique issues through the examination of complex claims activities, providing guidance to the PBM to act on behalf of the plan and the member.
• Engage in preparation activities for new benefit plan years, partnering with Product and Clinical teams to resolve inquiries related to Medicare Part D plans, including Mail Order Pharmacy.
• Investigate and resolve enrollment, billing, claim, and customer service issues, communicating solutions to both internal and external clients.
• Independently manage and prioritize your workload to meet deadlines and expectations.

MINIMUM QUALIFICATIONS:

• High School Diploma/GED
• 3 years of experience with Medicare Part D/Pharmacy benefits and/or PBM, related to eligibility, benefits, and/or claims adjudication
• At least 1 year of experience in pharmacy claim analysis and quality practices

PREFERRED EXPERIENCE:

• BA/BS degree or equivalent work experience
• Knowledge of RxClaim processing system
• Proficiency in Microsoft Word, Excel, PowerPoint, SharePoint, and Visio
• Familiarity with Medicare Part D guidelines and regulations
• Experience with Prior Authorization systems and CMS compliance guidelines
• Ability to prioritize multiple tasks and manage projects and deadlines effectively
• Proven business analysis skills and experience in continuous process improvement
• Strong analytical, detail-oriented, organizational, problem-solving, and follow-through skills
• Capability to analyze large data sets and handle complex requests
• Excellent problem-solving skills and the ability to build strong business relationships
• Outstanding oral, written, and presentation skills for both external clients and internal leadership stakeholders

If you are a self-motivated individual with a passion for improving member experiences in the Medicare Part D space, we encourage you to apply and join their dedicated team.

Apply Now!

ABOUT US:

Russell Tobin is a leading minority-owned professional and technical recruitment and staffing advisory organization.

We are comprised of specialized practices focusing on a variety of skill sets and industries. Having a depth and breadth of industry expertise, our subject matter experts are able to provide tailored and swift sourcing solutions to fulfill client hiring needs. In other words, we connect top talent with companies.

As a certified minority-owned business, Pride Global and its affiliates - including Russell Tobin, Pride Health, and Pride Now - are committed to creating a diverse environment and are proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, disability, age, veteran status, or other characteristics.

Russell Tobin offers eligible employees comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), a 401(k)-retirement savings, life & disability insurance, an employee assistance program, identity theft protection, legal support, auto and home insurance, pet insurance, and employee discounts with some preferred vendors.

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