PBM SME

Job Description

Innova Solutions is immediately hiring for a PBM SME

Position type: Onsite.

Duration: Permanent

Location: Atlanta

As a PBM SME you will:

• Candidate should have deep understanding of Pharmacy Benefit Management (PBM) business processes - including Claims Adjudication, Data related processes (e.g. Eligibility data, Provider data, Drug data, Formulary data, Drug Utilization reviews) and their interconnections. Strong plus if candidate has experience with Electronic Prescriptions and Prior-Authorizations related standards.
• Deep understanding of related PBM standards from NCPDP. Strong plus if candidate also understands CMS regulations related to Medicare & state Medicaid Pharmacy programs.
• Candidate should have deep understanding of First Data Bank (FDB) Drug nomenclature and how to use FDB nomenclature in designing / configuring drug coverage (inclusions/exclusions/PA Criteria) or building Formulary / Preferred Drug Lists. In lieu of FDB, MEDISPAN data experience will be acceptable.
• Candidate should be well informed about current industry trends and evolving standards.
• College degree is preferred. Industry experience can be considered as substitute.
• Candidates who have strong Clinical background (e.g. Pharmacists) and some BA background are welcome to apply (provided they are willing to switch to being a full-fledged BA with inhouse training.
• Provide PBM Subject Matter Expertise for both Conduent (Development and Testing team) and non-Conduent stakeholders (e.g. Customers)
• Own responsibility for creating requirements specifications / design documents (e.g. wire-frames, decision tables) to help developers produce technical specifications.
• Own responsibility for configuring drug plan benefits (e.g. Covered drugs, Pricing configuration, PA requirements) using Conduent PBM system.
• Interact with business and clinical users to elicit and understand business requirements, Translate the requirements into appropriate format for consumption by Development and Testing team.
• Good working knowledge on creating Process workflow or Use Cases, PowerPoint slides, Wireframes, Workflows using Microsoft Visio, analyze data using Microsoft Excel is needed to be effective at Requirements management, Translating and simplifying requirements.
• Document product features/requirements related documentation, prepare roadmaps (with aid of tools such as Visio, Power point)

The ideal candidate will have:

• Must have NCPDP experience.

• Ideally 10+ years' experience working in PBM domain (Claims processing related).
• Willing to consider less experienced candidates who can demonstrate depth in understanding PBM area.

Qualified candidates should APPLY NOW for immediate consideration! Please hit APPLY to provide the required information, and we will be back in touch as soon as possible.

Thank you!

Kiran Vajrala

Manager

PAY RANGE AND BENEFITS:

Pay Range*: 115,500- 135,500

*Pay range offered to a successful candidate will be based on several factors, including the candidate's education, work experience, work location, specific job duties, certifications, etc.

Benefits: Innova Solutions offers benefits( based on eligibility) that include the following: Medical & pharmacy coverage, Dental/vision insurance, 401(k), Health saving account (HSA) and Flexible spending account (FSA), Life Insurance, Pet Insurance, Short term and Long term Disability, Accident & Critical illness coverage, Pre-paid legal & ID theft protection, Sick time, and other types of paid leaves (as required by law), Employee Assistance Program (EAP).

ABOUT INNOVA SOLUTIONS: Founded in 1998 and headquartered in Atlanta, Georgia, Innova Solutions employs approximately 50,000 professionals worldwide and reports an annual revenue approaching $3 Billion. Through our global delivery centers across North America, Asia, and Europe, we deliver strategic technology and business transformation solutions to our clients, enabling them to operate as leaders within their fields.

Recent Recognitions:

• One of Largest IT Consulting Staffing firms in the USA - Recognized as #4 by Staffing Industry Analysts (SIA 2022)
• ClearlyRated® Client Diamond Award Winner (2020)
• One of the Largest Certified MBE Companies in the NMSDC Network (2022)
• Advanced Tier Services partner with AWS and Gold with MS

Website : https://www.innovasolutions.com/

Innova Solutions is an Equal Opportunity Employer and prohibits any kind of unlawful discrimination and harassment. Innova Solutions is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment on the basis of race, color, religion or belief, national origin, citizenship, social or ethnic origin, sex, age, physical or mental disability, veteran status, marital status, domestic partner status, sexual orientation, or any other status protected by the statutes, rules, and regulations in the locations where it operates. If you are an individual with a disability and need a reasonable accommodation to assist with your job search or application for employment, please contact us at [email protected] or (770) 493-5588. Please indicate the specifics of the assistance needed. Innova Solutions encourages all interested and qualified candidates to apply for employment opportunities. Innova Solutions (HireGenics/Volt) does not discriminate against applicants based on citizenship status, immigration status, or national origin, in accordance with 8 U.S.C. § 1324b.

The company will consider for employment qualified applicants with arrest and conviction records in a manner that complies with the San Francisco Fair Chance Ordinance, the Los Angeles Fair Chance Initiative for Hiring Ordinance, and other applicable laws.