As one of the nation’s largest not-for-profit Medicare Advantage plans, serving more than 200,000 members in California, SCAN Health Plan has been a mission-driven organization dedicated to keeping seniors healthy and independent for over 40 years. SCAN employees are passionate about what they do, and understand that success is based on achieving the mission. Employees are afforded with the training and tools necessary to do their jobs and are rewarded for their efforts and recognized as experts in their fields. To learn more, visit scanhealthplan.comor follow us on social media:LinkedIn; Facebook; andTwitter.
The Lead Pharmacy Analyst oversees the daily operational functions and oversight of the SCAN Pharmacy Benefit Management (PBM) company on delegated Part D functions. Provides work direction, training and guidance to Pharmacy Analysts performing daily operations and ensures Part D deadlines/timeframes are met. Serves as a subject matter expert on Part D Reporting, Prescription Drug Event data, Drug Plan Finder process, and Financial Information Reporting to ensure compliance with Part D requirements.
Lead a team of Pharmacy Analysts by providing work direction and conducting quality reviews of daily assignments. Assess team workloads, prioritize projects, ensure completion within specified deadlines and assist with daily work or projects as needed.
Assist the Manager in coaching team for continued job growth and skills development as the work necessitates.
Serve as a subject matter expert for Part D Reporting requirements, Pharmacy Access Requirements, Prescription Drug Event data, Financial Information Reporting and Drug Plan Finder files by keeping up to date with Medicare requirements.
Ensure eligibility and coordination of benefit files are sent to the PBM for processing and assess if file enhancements are needed.
Ensure the PBM is processing Prescription Drug Events, Automated Claims Reprocessing and Financial Information Data according to CMS regulatory standards by conducting daily oversight.
Ensure PBM oversight of claims adjudication, retro-lics, prescriber id information to minimize fraud/waste/abuse.
Analyze and monitor large data sets that are exchanged from SCAN to the PBM using a variety of reporting tools.
Ensure audit documentation is prepared according to audit instructions and provided within the specified audit time frame. Prepare written responses or documentation for pharmacy audits.
Provide Pharmacy Analyst team support by communicating job expectations, giving continual feedback, enforcing policies and procedures, and conducting training programs.
Perform routine monitoring to ensure Part D compliance and detect performance issues or operational gaps. Provide corrective feedback and recommendations to staff or PBM, and ensure follow through.
Provide assistance to internal and external customers at SCAN, by troubleshooting and problem solving pharmacy related issues.
Conduct training sessions on pharmacy benefits and Part D programs to other departments as needed.
Maintain professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
Other duties as assigned.
High School Diploma, GED, or equivalent work experience is required.
Bachelor's Degree preferred.
Pharmacy Technician License for the State of California is preferred.
5+ years of experience working in a health plan or PBM (Help Desk).
Experience leading a work team is preferred.
Experience with file management and working with different file formats (e.g. text files).
Regulatory audit experience.
Experience managing small projects from inception through completion.
Claims adjudication experience is preferred.
Expert knowledge of CMS Part D regulations e.g., CMS Call Letters, MA-PD application, PDE, LICS, Claims Processing, Part D Reports, FIR.
Knowledge of PDE calculations that pertain to Enhance Alternative Plans, Coverage Gap, etc.
Ability to prioritize workload to meet deadlines.
Excellent grammar and writing skills.
Excellent verbal skill sets to be able to communicate in conference calls and in large meetings.
Team player with a strong work ethic.
Ability to multi-task in a fast pace environment.
Self-starter that can take the lead on a project and manage its progress for completion.
Detail oriented and is able to work with large data sets.
Advanced skills with Microsoft Office 2016 e.g., Word, Excel, Access, SQL and PowerPoint.
Familiarity with Tableau is preferred.
Excellent organizational capabilities with ability develop partnerships and strong working relationships within the organization and with the PBM.
Ability to interact effectively and professionally with all levels of staff.
What's in it for you?
A competitive compensation and benefits program
An annual employee bonus program
Generous paid-time-off (PTO)
Ten paid holidays per year
Excellent 403(b) Saving Plan, providing up to 4% match and vesting after three years
A work-life balance and much more!
We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!
At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.
SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employee will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.
Internal Number: PHARM03640
About SCAN Health Plan
As one of the nation’s largest not-for-profit Medicare Advantage plans, serving more than 200,000 members in California, SCAN Health Plan has been a mission-driven organization dedicated to keeping seniors healthy and independent for over 40 years. SCAN employees are passionate about what they do, and understand that success is based on achieving the mission. Employees are afforded with the training and tools necessary to do their jobs and are rewarded for their efforts and recognized as experts in their fields. To learn more, visit scanhealthplan.com or follow us on social media: LinkedIn; Facebook; and Twitter.