Pharmacy Part B Analyst

Job Description:

Position Summary:

Utilizing established operating procedures, the Part B Analyst will oversee the Part B Prior Authorizations and be responsible for improving the process. Develop and maintain various audits and QA processes. Support the operations of the Pharmacy Department.

General Responsibilities:

Responsible for overseeing the Part B Prior Authorization process. Coordinate with any team members assisting in this process, including Pharmacy Support Specialists and Clinical Pharmacist, to ensure requests are processed in accordance with CMS guidelines. Provide input to improve exception's process.

Responsible for providing all reporting associated with the Part B PA process.

Answer incoming calls regarding PA's as well as other claims processing issues and determine appropriate course of action.

Develop and maintain QA processes including Facets and Part B PA database.

Perform audits of the pharmacy benefit as needed for Pharmacy Operations Manager and Director of Pharmacy.

Develop and maintain a process to track cost savings.

Responsible for knowing and interpreting Part B pharmacy benefits and CMS regulations

Assist the Care Improvement Plus claims department in pricing and review of Part B drug claims

Provide support for other Pharmacy Department operations as needed.

Required Education and Experience

Bachelors Degree and minimum of two years experience in a managed care or pharmacy setting or a combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the positio

We are proud to be an EEO/AA employer M/F/D/V. We maintain a drug-free workplace and perform pre-employment substance abuse testing.



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