Pharmacy Program Oversight Sr. Business Analyst - Minnetonka, MN or Telecommute - Full-time / Part-time

UnitedHealthcare Medicare & Retirement (UHMR) Pharmacy Management team provides pharmacy benefit operation services, formulary and clinical operations services, and is responsible for executing oversight and monitoring activities of UHMR’s first-tier, downstream and related entities (FDR).  The Pharmacy Management team’s primary focus relates to UHMR’s pharmacy benefit management (PBM) services provided by OptumRx.  UHMR is a family of UnitedHealth Group businesses dedicated to improving the health and well-being of Americans ages 50 and older.
 
UHMR Pharmacy Management is searching for an expert problem-solver with experience in Medicare Part D claims processing and business processes.  The selected candidate will join the Pharmacy Program Oversight Team in Minnetonka, MN as the Sr. Business Analyst supporting Part D audits.  In this highly visible and growth-oriented role, you will report to the Director of Pharmacy Program Oversight and play a key role in supporting Part D Audits and related business activities as a member of the Pharmacy Audit Support Team (PhAST).
 
Primary Responsibilities:

Understand the overall business model of Medicare Part D products, CMS guidance and the PBM claim adjudication system and translate concepts into practice
Support CMS audit initiatives by investigating samples, reviewing supporting documentation, identifying scenarios of concern, and researching claims within the pharmacy system
Drive follow-up activities required to address identified gaps
Collaborate with business stakeholders and PBM to obtain necessary information to support audits
Support Pharmacy Program Oversight business activities related to paid and rejected claim reviews and member impact reporting and remediation 
Participate in business requirements development and system testing, research and analyze claim data for root cause identification, correction and remediation
Support development of Audit Support team infrastructure and proactive audit monitoring programs
Support for ongoing Audit Readiness activities
Prioritize and organize own work to meet deadlines

Required Qualifications:

Bachelor's Degree or 4 years of equivalent education and / or work experience
3 years Medicare Part D / Pharmacy benefit, and / or PBM experience related to eligibility, benefits and / or claims adjudication
2 years of experience analyzing large amounts of data and handle complex requests
2 years of experience with reporting
Intermediate level of proficiency with Microsoft Word, and Power Point
Experience in Excel including pivot tables, basic formulas, and importing and exporting data
Experience with business analysis and continuous process improvement
Preferred Qualifications:

Certified Pharmacy Technician experience
Experience with Pharmacy Claim Analysis and quality practices
Knowledge of RxClaim (claims processing system)
Experience with either SAS or SQL and Oracle / SQL
Proficiency with SharePoint and Visio
Knowledge of Medicare Part D guidelines and regulations
Ability to travel up to 10 percent
Experience working in a Matrix environment
Careers at UnitedHealthcare Medicare & Retirement. The Boomer generation is the fastest growing market segment in health care. And we are the largest business in the nation dedicated to serving their unique health and well-being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You'll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our health care system. Ready? It's time to do your life's best work.(sm)
 
 
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
 
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
 
 
Job Keywords: Rx, PBM, pharmacy, part D, claims, Minnetonka, Minnesota, MN, remote, work from home, telecommute, telecommuter, telecommuting