Job ID: NC-694145 (93691108)
Hybrid Healthcare Pharmacy BA with claim adjudication, FDB, NDCs, GCNs, GSNs, Medicaid PDL, rules experience
Location: Raleigh, NC NCDHHS
Duration: 12 Months
Skills :
Experience with Pharmacy claim adjudicationRequired3Years
Working knowledge of First Data Bank (FDB) drug classifications such as therapeutic drug classes, NDCs, GSNs, GCNs, etc.), drug dosage, packaging/pricRequired3Years
Understanding of Medicaid PDL (for generic and brand drugs)Required3Years
Understanding of preferred/non-preferred drug, prior authorization criteria/rules, lock-in program requirements and drug utilization reviewRequired3Years
Experience with gathering requirements and interpreting business rulesRequired3Years
Highly proficient with Microsoft Outlook, Word and ExcelRequired3Years
Excellent communication, negotiation, conflict resolution and persuasion abilitiesRequired3Years.
This position will be responsible for managing the relationship between the Division’s pharmacy program and the system functionality that enforces the business rules and requirements specific to pharmacy operations within the Medicaid program.
NC DHHS Division of Health Benefits is seeking a Business Systems Analyst.
This position will be responsible for managing the relationship between the Division’s pharmacy program and the system functionality that enforces the business rules and requirements specific to pharmacy operations within the Medicaid program.
Job Specific Responsibilities:
Monitor PHP data reports and identify issues
Research Pharmacy issues
Identify defects and track to resolution
Request system enhancements and track to resolution
Preferred Knowledge, Skills, and Abilities:
•Experience with Pharmacy claim adjudication
•Working knowledge of First Data Bank (FDB) drug classifications such as therapeutic drug classes, NDCs, GSNs, GCNs, etc.), drug dosage, packaging and pricing
•Understanding of Medicaid PDL (for generic and brand drugs), preferred/non-preferred drug, prior authorization criteria/rules, lock-in program requirements and drug utilization review (both ProDUR and RetroDUR).
•Experience with gathering requirements and interpreting business rules
•Demonstrated ability to work independently in a fast-paced environment with concurrent deadlines
•Excellent communication, negotiation, conflict resolution and persuasion abilities
•Strong organizational, time management, communication, and detail-oriented skills
•Highly proficient with Microsoft Outlook, Word and Excel