Position Title: Prescription Plan Design & Escalations Analyst
Work Location: Phoenix, AZ 85021
Assignment Duration: 3+ Months
Key Responsibilities:

• LEVEL 1 – PERFORMS JOB FUNCTIONS UNDER CLOSE SUPERVISION OR PEER REVIEW
• Analyze PBM prescription claim and other applicable systems for medication benefit quality and accuracy
• Support internal and external customers with information on benefits applicable to medication claims
• Perform, evaluate, and assist in defining and improving the quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines.
• Administer, interpret, and maintain current working knowledge of required our organization systems, procedures, forms and manuals
• Communicate recommendations in regard to medication claim processing and benefit decisions.
• Monitor and investigate reported plan set up system issues
• Participates in quality initiatives; including functions that support audits, reporting, evaluation of quality opportunities and concerns, and creation and implementation of corrective actions as requested.
• Resolve escalated member issues
• Research & provide recommendations for accumulations issues
• Logs all benefit setup issues on error tracking reports
• Provide monthly updates on error resolutions and impact reports
• LEVEL 2 – PERFORMS JOB FUNCTIONS WITH MINIMAL SUPERVISION
• Communicates issues identified within vendor system effectively to team.
• Communicates issues identified within plan setup testing or another escalated research to team
• Strategizes solutions for issue resolution and communicates plans to team.
• Provides written documentation for desk levels.
• Provides support to other team members when necessary
• Review plan testing documents for minimal accuracy
• LEVEL 3 – PERFORMS JOB FUNCTIONS WITH MINIMAL SUPERVISON, ACTS AS SUBJECT MATTER EXPERT
• Primary liaison for Pharmacy Management for applicable benefit design questions
• Primary SME contact for various internal departments within our organization In regard to pharmacy plan setup and design
• Builds reporting and analyzes data for benefit recommendations to management.
• Review and determine pharmacy benefit setup upon renewal for all benefit plans
• Build and setup all new pharmacy benefits in the pharmacy system; including standard patient pays
• Submit drug code assignments to enrollment for all benefit plans Maintain pharmacy drug code matrix
• LEVEL 4 – LEAD – PERFORMS JOB FUNCTIONS AS ASSIGNED AND ALLOCATES RESOURCES AND PROJECT PRIORITIZATION
• Perform quality checks and analysis on drug code setup from other analysts
• Review escalated plan testing questions for accuracy and make corrections as needed
• Setup all complex pharmacy benefit plan designs
• Setup all complex patient pays, and any other design element related to complex pharmacy benefits
• Works with Pharmacy Management Leadership team to identify project prioritization
• Allocates resources to ensure required work is accomplished within defined time frames
• Assigns Tasks to Analysts and Specialists as needed
• ALL LEVELS
• Each progressive level includes the ability to perform the essential functions of any lower levels and mentor employees in those levels.
• Properly track all pharmacy benefit issues & concerns
• The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
• Perform all other duties as assigned.
  
  Qualification & Experience:
• Intermediate PC proficiency with word processing, spreadsheets, and claims and imaging software (Level 1)
• Intermediate skill using office equipment, including copiers, fax machines, scanners and telephones (all Levels)
• Advanced PC proficiency, including spreadsheet and vendor application software (Levels 2 and 3)
• High-School Diploma or GED

 
 
At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $ 32.00/hr.