Description

You will act as a subject matter expert for Pharmacy Benefits Management (PBM) systems and business processes within large Federal or State programs, owning end-to-end analysis, integration design, and documentation.

Responsibilities

• Evaluate existing business processes, anticipate requirements, and coordinate software solution implementation.
• Design system integrations and interfaces while managing defects through user acceptance testing.
• Gather, document, and maintain business requirements, QA documents, and project deliverables.
• Query database tables using SQL to generate reports, analyze data, and support decision-making.
• Collaborate with business units, vendors, and stakeholders to manage competing tasks and priorities.

Required Skills

• 4+ years of Pharmacy Benefits Management (PBM) business and system experience.
• 7+ years of experience working on large Federal or State programs.
• 7+ years of experience designing system integrations and interfaces.
• 7+ years of experience with verbal and written communication for technical and business audiences.
• 4+ years of experience working with Agile methodologies.
• 3+ years of experience writing Business and QA documents.
• Extensive knowledge of PBM statutes, rules, NCPDP, Drug Rebate Processing, RetroDUR, EDI, X12, HL7, HIPAA PHI, and ICD-10.
• Proficiency in SQL, including writing complex queries and querying database tables.
• Proficiency with Microsoft Word, Excel, Visio, PowerPoint, Project, Outlook, and OneNote.

Preferred Skills

• Experience with Managed Care, Medicaid, and Project Management.
• Familiarity with System Integrator Platforms, JIRA, SCRUM, and Agile methodologies.

Key Skills

Education

Any Graduate