Job Description

Job Title: Government Program Analyst, Pharmacy Services
Job ID: 725574
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: PHARMACY SRVCS
Location: 600 Grant St, Pittsburgh PA 15219

Description

UPMC Health Plan is hiring a full time Government Program Analyst to support our Pharmacy Services team. This will be a Monday through Friday daylight role located in downtown Pittsburgh at the US Steel Building. This position will require occasional weekend shifts as needed by the department.


Under the general direction of Pharmacy Department Management, the Government Program Analyst is responsible for monitoring Pharmacy Department processes to promote compliance with applicable regulations and internal policies and procedures. Additionally, the Government Program Analyst organizes, and maintains detailed documentation of all activities, and assists with gathering information for both internal and external audits and inquiries.


Responsibilities:
  • Analyze reports and assist with tracking and trending of issues and errors to identify training opportunities and/or opportunities for process improvements.
  • Assist with the timely completion and submission of government-required reports and documentation.
  • Communicate effectively in both verbal and written interactions.
  • Conduct outbound calls to clarify and resolve inquiries and potential issues, as needed.
  • Document all activities consistently and clearly, following established department procedures.
  • Interpret and investigate potentially incorrect rejected pharmacy claims.
  • Maintain employee and insured confidentiality.
  • Maintain readily accessible and highly organized documentation to facilitate effective, accurate responses to internal and external information requests.
  • Monitor Pharmacy Department processes, including, but not limited to coverage determination and exceptions procedures, to promote continued compliance with regulations.
  • Must be flexible with responsibilities and have an ability to multitask.
  • Participate in monitoring and oversight of Pharmacy Department's third party vendors.
  • Review websites and other documents for accuracy of plan information.
  • Track identified issues and follow up with responsible individuals, as necessary, until remediation is complete.

Qualifications

  • High school graduate or equivalent required.
  • B.A. degree preferred.
  • One year of experience in managed care plans required.
  • Experience with Medicare preferred.
  • Working knowledge of pharmacy claim processing procedures and coverage determinations preferred.
  • Excellent communication, organizational, documentation, analytical, and problem solving skills.
  • Attention to detail is critical.

Licensure, Certifications, and Clearances:
UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $18.24 to $30.32

Union Position: No

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