Health Value Analyst jobs in Florence, SC

Title:

Pharmacy Business Analyst

Reports To:

Pharmacy Director

Updated on:

January 31, 2024

Status:

Exempt

Approved By:

POSITION SUMMARY

The Pharmacy Business Analyst is responsible for pharmacy reporting and understanding in detail the pharmacy billing policies, Third party payers, formularies, and other operations of the pharmacy business. As a key member of our team, you will develop a deep understanding of the business side of the pharmacy and actively contribute to its improvement.

PRIMARY ACCOUNTABILITIES

Achieve Results

• Evaluate all prescriptions for proper adjudication according to pharmacy policies.
• Maintain contract pharmacy compliance.
• Responsible for daily and monthly reporting.
• Ensure Prior Authorizations are up-to-date and documented and appeals are managed.
• Become an expert in running the pharmacy software backend reporting tools.
• Responsible for Third party analysis.
• Understand in detail all compliance related requirements for the pharmacy.

Operational Excellence

• Ensure and uphold the confidentially requirements of all patient records and manage all daily task and activities consistent with HIPAA, state and federal laws and regulations, as well as the clinic’s policies and regulations regarding confidentiality and security.

Relationships

• Develop and ensure effective, positive relationships within and among the clinical and pharmacy staff, as well as with patients, vendors, contractors, and related resources.

Professionalism

• Ensure all actions, job performance, personal conduct and communications represent the organization in a highly professional manner at all times.

11. Uphold and ensure compliance with and attention to all corporate policies and procedures, as well as the mission and values of the organization.

PRIMARY TASKS & DUTIES

• Responsible for preparing and distributing daily reports and month end reports.
• Thoroughly review daily reports for issues affecting the pharmacies performance.
• Make recommendations to improve the financial performance of the pharmacy.
• Understand and be able to operate all internal and external software programs.
• Work collaboratively with multiple business units, vendors, teams, and stakeholders.
• Respond to questions by patients, providers, and other professional personnel.

ESSENTIAL FUNCTIONS/KEY COMPETENCIES

• Function in a multi-tasking, multiple priorities environment, while maintaining accuracy and attention to detail.
• Utilize a wide variety of office technology and tools to collect, enter, process, file patient records and documentation.
• Be knowledgeable of all administrative aspects related to case management and disease management department.
• Have a patient first attitude and good attention to detail for our specialty patients that have more complex diseases or conditions.
• Stay up to date with new medications and be willing to learn and challenge yourself.

POSITION REQUIREMENTS

Education

· College Degree in Pharmacy

· SC Board of Pharmacy license in good standing

· Clinical Pharmacy experience preferred but not required

Physical/Environmental

· Ability to interact with computer screen for up to six hours at a time (visual acuity required).

· Must have manual dexterity for use of keyboard. Ability to remain stationary for periods of up to four hours. Ability to communicate via phone, mail and in person to resolve disputes, solve problems, etc.

· Capacity to function in a sometimes stressful, multi-tasking environment

Blood Borne Pathogen Exposure (Please Check One)

_____ Category I: Job classification includes ALLemployees who have occupational exposure* to blood borne pathogens* (blood or body fluids) while performing their job duties.

____ Category II: Job classification includes employees who are likely to have SOME occupational exposure to blood borne pathogens because Category I tasks may occasionally be required.

____ Category III: Job Classification includes those employees who perform jobs and tasks where NO CONTACT with blood borne pathogens occurs and Category I and Category II tasks ARENOT a condition of employment.

LIMITATIONS/DISCLAIMER:

1. The above job description is meant to describe the general nature and level of the work being performed; it is not intended to be construed as an exhaustive list of all job responsibilities, duties and skills required for the position.

2. All job requirements are subject to possible modifications to reasonably accommodate individuals with disabilities. Some requirements may exclude individuals who pose a direct threat or significant risk to the health and safety of themselves or other employees.

3. This job description in no way states or implies that these are the only duties to be performed by the employee occupying this position. Employees will be required to follow any other job-related duties requested by their supervisor in compliance with federal and state laws.

4. Requirements are representative of minimum levels of knowledge, skills, and/or other abilities. To perform this job successfully, the employee must possess the abilities or aptitudes to perform each duty proficiently. Please review the employee handbook carefully. It determines the nature and extent of the employment relationship, and you must familiarize yourself with its contents, and adhere to all of the policies and procedures of GHC, whether set forth in the handbook or elsewhere. The policies, procedures and standard practices described in the manual, including this document, are not conditions of employment. The manual does not create an express or implied contract between GHC and any of its employees. GHC reserves the right to terminate any employee, at any time, with or without notice or procedure, for any reason deemed by the Company to be in the best interests of the Company, including for no reason at all. The information in the handbook and/or otherwise presented by the Company represents guidelines only, and GHC reserves the right to modify the handbook, amend or terminate any policies, procedures, or employee benefit programs whether or not described in the handbook at any time, or to require and/or increase contributions toward these benefits programs.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday
• No nights
• No weekends

License/Certification:

• Degree in Pharmacy (Required)

Ability to Relocate:

• Darlington, SC 29532: Relocate before starting work (Required)

Work Location: In person