PBM Operations Analyst

ABOUT RIGHTWAY

At Rightway we are committed to creating a diverse environment and are proud to be an equal opportunity employer. We hire the      best talent and actively seek diversity of thought processes, beliefs, background, and education. Rightway fosters an inclusive culture where differences are celebrated to drive the best business decisions possible.

We are committed to equal opportunity and fairness regardless of race, color, religion, sex, gender identity, sexual orientation, nation of origin, ancestry, age, physical or mental disability, country of citizenship, medical condition, marital or domestic partner status, family status, family care status, military or veteran status or any other basis protected by local, state or federal laws.

Rightway Healthcare was founded in early 2017 by a team of dedicated healthcare, business, and technology leaders. Rightway is a technology platform that provides employees and their families with the support, information, and advocacy they need to be better healthcare consumers.

We combine a high-tech consumer portal with a high-touch dedicated concierge environment to provide consumers with the same level of support and guidance they would receive if they had a doctor in the family. We are focused on personalization, implementation, advocacy, and results.

Rightway works with employers from 100 – 25,000 employees to provide an ecosystem of healthcare navigation for employees. We are committed to generating high member satisfaction scores, industry leading engagement and a quantifiable ROI for every employer. Our approach is rooted in analytics and guided by a bottom-up understanding of a population.

Rightway is privately financed, having raised over $30mm to date from investors such as Thrive Capital

It is headquartered out of New York City, with new offices in Hudson Yards. We also have remote offices in Miami, FL and San Francisco, CA.

ABOUT THE ROLE

Our pharmacy benefit management (PBM) offering represents an important growth area for Rightway.  Helping clients better manage pharmacy spend to make drugs more affordable for their employees and dependents is critical to their business sustainability.  Rightway is responsible for designing, building, and operating a new-to-the-world PBM model base on our core tenets: fairness & transparency, unlocking the supply chain, supporting the physician-patient relationship, and utilizing navigation to empower consumers

The PBM Operations Analyst is a member of the Rightway Operations team reporting to the Director, Claims & Data Operations. This role will be responsible for the configuration, testing and maintenance of benefits, and related claims adjudication rules within the claim platform along with ongoing management of data operations.

RESPONSIBILITIES

RESPONSIBILITIES 

• Support the execution of all eligibility and accumulator operations and interfaces from implementation through ongoing operations and maintenance.
• Serve as day-to-day contact for all eligibility and accumulator needs. 
• Collaborates with technology, account management, benefit administration, and other internal stakeholders to ensure that eligibility and accumulator functions are implemented and operating in accordance with requirements.
• Oversee all downstream vendor feeds (i.e. ID card fulfillment), third party integrations (i.e. health plans, TPAs) and ensures all deliverables are met timely and troubleshoots issues.
• Configures benefits into the claim adjudication platform, including benefit inclusions/exclusions copay, accumulator, and other benefit parameters.  
• Develops and executes on test scenarios to ensure accuracy of benefit setup both at initial setup and conducts ongoing monitoring and regression testing.  Works to correct all identified defects.
• Performs research and troubleshoots inquiries or issues related to claims adjudication, accumulators, and eligibility.
• Ensures all documentation regarding setup and internal controls is always up to date.     

REQUIREMENTS 

• Education Level: Bachelor’s degree preferred. Relevant experience considered for exceptional candidates.
• Pharmacy Technician or related experience highly desirable
• Work experience: 1-3 years of PBM experience in claims or benefit configuration     
• Location information:  NYC or Denver, highly qualified remote candidates will be considered
• Important characteristics of ideal candidate:  Detail-oriented, intellectually curious, ability to challenge the status quo, consultative with internal and external clients, ability to think critically      and problem solve, ability to work in a fast-paced environment with shifting priorities.
• Specific skills needed for job:  Extensive knowledge of pharmacy benefit configuration and claims processing. Working knowledge of Medispan.