Pharmacy Operations Analyst

JOB SUMMARY:
The operations analyst will support the CMS/Medicare operations requirements for AMERIGROUP’s Medicare-PartD SNP program. Continual CMS requirements and guidance requires support of the Medicare Operations Team in ensuring that proper changes are made to meet these requirements. Many of the deliverables associated with this position are time sensitive. The operations analyst will assimilate changing requirements and data deliverables to fit internal and government requirements. This position will interface with other areas within the organization as new processes are written to support the CMS/Medicare program. The operations analyst will interface with the Medicare Operations Team and AMERIGROUP’s PBM on a regular basis in the collection, review, quality assurance, and distribution of specific files. As business needs dictate, the role of this position could change.

PRIMARY RESPONSIBILITIES:
Interface with multiple departments as a subject matter expert for Medicare part D issue resolution.
Interface with the PBM and others to collection, review, and provide quality assurance and distribution of specific files
Coordinate the pharmacy EOB process, including maintenance of procedures, ensuring the process runs each month, reviewing and revising the notices of formulary changes for distribution with EOBs, and handling plan to plan information exchanges of TROOP and other EOB info.
Coordinate CMS formulary management (console updates), including submission of monthly formulary changes and negative formulary change notices to CMS for approval, coordinating monthly plan finder pricing file submissions with IT, revising template plan finder formulary files and forwarding to IT for submission, coordination with Communications and Creative Services to produce updates of print and on-line versions of formulary
Coordinate/facilitate file transmissions between PBM, IT and CMS including formulary change files, price files, rebate files, network files and PDE files
Review and prepare responses to emails from CMS
Coordinate requests for coverage determinations, formulary exceptions and tiering exceptions
Coordinate with PBM to obtain network updates for pharmacy section of provider directory
Coordinate, gather and format information for quarterly data reporting to CMS including utilization stats, prior authorization stats, transactions, rejections and reversals and MTMP reports
Assist with activities related to new SNP implementations.
Assemble monthly, quarterly and annual required reports
All other operational duties as needed to meet business needs
REQUIREMENTS
EDUCATION AND EXPERIENCE:
Strong interpersonal and communication skills (written and verbal). Excellent problem solving skills. Ability to read, analyze, and interpret government regulations. Ability to organize, think critically and multi-task. Ability to consolidate information from varied sources. Well developed computer skills: micro-soft office suite

Education:
Required: Bachelors Degree in Healthcare or Business
Preferred:
Years and Type of Experience:
Required: 2 years of health care operations, legal, project management or other comparable experience.
Must have some IT and/or pharmacy experience
Preferred:
Specific Technical Skills:
Required: MS office, MS outlook, MS Explorer
Other:
Required: Excellent oral and written communication skills; Comfortable promoting the AMERIGROUP Pharmacy Program to members, physicians, pharmacists, and other healthcare professionals; Be advocate for managed care pharmacy; Appreciation of cultural diversity and sensitivity towards target population; Ability to complete multiple projects and meet deadlines; May require rotating second shift work or weekends;
Preferred: Multi-lingual (especially Spanish) desired

PHYSICAL REQUIREMENTS
Must be able to operate a computer using multiple software programs simultaneously and tolerate large amount of time working from a computer screen.
Data entry using repetitive motions of fingers and forearm.
Must be able to operate a telephone.
Must be able to tolerate standing and sitting for long periods of time.
Repetitive bending and stooping
Must be able to lift boxes or materials up to 40 lbs.

AMERIGROUP Associates help make a difference in the hundreds of lives they touch every day. We understand that many of our members are moms and kids who depend on us to help them get the health care their family needs. If you share our commitment to improving people's lives, AMERIGROUP may have a place for you. AMERIGROUP Corporation is committed to associate career development and growth, providing opportunities in a culturally diverse, energetic environment. We take pride in offering extensive training programs, competitive compensation, incentives and excellent benefits including:
Relocation Assistance
Paid Accumulated Leave
Holidays
Medical Insurance
Dental Insurance
Life Insurance
Short-Term Disability
Long-Term Disability
401(k)
Employee Stock Purchase Plan
Flexible Spending Accounts
Employee Assistance Program
Company Sponsored Training
Departmental Incentives
Continued Career Growth and Development Opportunities

AMERIGROUP Corporation, headquartered in Virginia Beach, Virginia, is a multi-state managed health care company focused on serving people who receive health care benefits through public-sponsored programs including Medicaid, State Children's Health Insurance Program, and FamilyCare. The Company currently operates in 9 states and the District of Columbia.

In 1994, AMERIGROUP was founded to respond to the growing need for private-sector partners in state managed health care programs for lower-income families and people with disabilities. Since its inception, AMERIGROUP has been a proven leader in meeting the states' objectives of providing accountability and improving access to health care while still controlling care costs. Today, AMERIGROUP is the largest corporation focused exclusively on the health care needs of Medicaid recipients and the uninsured.

Our mission is to operate a community-focused managed care company with an emphasis on the public sector health care market. We will coordinate our members' physical and behavioral health care, offering a continuum of education, access, care, and outcome, resulting in lower costs, improved quality and better health status for Americans.

If you share our commitment to improving people's lives, AMERIGROUP may have a place for you. We're growing dramatically and would like you to consider working for a leader in the healthcare industry. AMERIGROUP Corporation is committed to associate career development and growth, providing unlimited opportunities in a culturally diverse, energetic environment.