At Kaiser Permanente, our focus on total health allows us to work as one. As one team driven by talented, passionate health care professionals. One community focused on making healthy choices. One organization using the latest innovations and most advanced care to serve 12.5 million people across the country. If you’re looking for an opportunity to make a real difference in each member’s mind, body, and spirit, join us at the heart of health care.
Analyst Network Pharmacy Benefits
In this role, you will act as a subject matter expert and key point of contact for pharmacy benefit configurations. You will provide technical assistance to statewide retail contracted pharmacies and internal staff to ensure accurate and consistent pharmacy and formulary compliance; serve as a facilitator to ensure coordination and integration of all assigned work processes; and maintain the benefit structures and edits for all lines of business in the various PBM and provider network systems. In addition, you will identify areas for standardization and process improvement and assist in the documentation of these items as well as collaborate with membership and billing staff to ensure adjudication of pharmacy benefits. Work from home/telecommuting permitted.
At least two years of relevant work experience with drug formulary in a retail pharmacy setting or experience with health plan, IT, claims, customer service, membership, configuration, or other areas of a large, complex health care or insurance provider
A high school diploma or GED
Preferred Qualifications Include:
Three years of relevant work experience with drug formulary in a retail pharmacy setting or experience with health plan, IT, claims, customer service, membership, configuration, or other areas of a large, complex health care or insurance provider
Three years of progressively responsible relevant experience in claims, customer service, membership, configuration, or other health plan functions requiring an in-depth knowledge of Epic, Lotus Notes, RxClaim systems
Experience working with a Pharmacy Benefits Manager
A bachelor’s degree in business, computer science, or related field or four years of experience in a directly related field
Skilled in working with computers and MS Office products
Skilled at multitasking and can manage working in a fast-paced environment
Strong interpersonal, problem-solving and collaboration skills
Washington State Pharmacy Technician License or thorough knowledge of generic/trade drug names, uses and categories with an in-depth understanding of a formulary, insurance, and/or medical terminology by date of hire/transfer
Strong verbal and written communications skills needed
Skilled in using independent judgment to accurately analyze situations and develop the best solution
Knowledge of benefit adjudication processes
For immediate consideration, please visit http://kp.org/careers for complete qualifications and job submission details, referencing job number 977164.
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.
This position supports Kaiser Permanente’s code of conduct and compliance by adhering to all laws and regulations, accreditation and licensure requirements, and internal policies and procedures.
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