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Job Description

Job Title: Gov't Prog Analyst, Pharm Svcs
Job ID: 913725315
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


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

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/Disability/Veteran

Salary Range: $19.17 to $31.85 / hour

Union Position: No

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