Adjudication Support Business Analyst Position Purpose:
The Care Services Adjudication Business Analyst is a primary support position that works closely with organization management to identify their customer needs and establish ways upon which customer needs can be met for their maximum benefit and satisfaction. This position provides project, tactical, and business requirements support to act as an efficient liaison between all business units and internal / external stakeholders.
- Design and oversee User Acceptance Testing (UAT) for all adjudication platforms on behalf of business units.
- Create, develop, and maintain standard business requirement documentation for usage by internal partners and submission to external vendors (Laker, PDMI, ScriptCare).
- Implement standard templates for ticket submission.
- Provide supplemental support for pharmacy configuration setup and maintenance in adjudication platforms; providing timely follow-up and follow-through.
- Pursue and establish internal Service Level Agreement (SLA) standards with all internal partners.
- Support internal projects where adjudication support can leverage system knowledge to improve opportunity for success.
- Assist in the pursuit and review of a new adjudication platform.
- Facilitate meetings and presentations to provide status updates and effective pharmacy configuration setup and adjudication platform decision making.
- Participate in the continuous audit of new contracts as well as support the cleanup efforts of existing contracts through the utilization of tools that allow for repricing of claims to determine outcomes in a proactive manner.
- Support projects across departments ensuring consistency in all project work; and leading stakeholders toward operational efficiencies in adjudication claim processing.
- Receive and complete pricing configuration within the adjudication platforms in support of all Care services Lines of Business.
Desired Education and Experience:
- Bachelor’s degree in Computer Science, Project Management, HealthCare, or related discipline.
- Four to seven years’ exposure to claims adjudication platforms.
- Two years’ experience as a Business Analyst driving requirement for business projects.
- Previous experience with pharmacy networks with Pharmacy Benefit Management related experience beneficial.
- Previous experience with Laker Software, PDMI, and ScriptCare.
- Demonstrated competence with Microsoft Office toolset.
Care Services LLC was founded in 2011 and manages a family of companies that focuses on the unique needs of the long-term care pharmacies and hospice providers.
The companies of Care Services offer a variety of comprehensive services, including claims adjudication, back-up medication fulfillment, on-call services, pharmacy benefit management, pharmacist consultations and on-demand delivery services.
Location/Region: Raleigh, NC (US)