Business Process Analyst – Use the Collaborative PBM Cloud™ business model and platform functionality to understand new client onboarding and maintenance of business activities across benefits, formulary, utilization management, data files, and network workstreams. Study the organizations existing processes and workflows to detect areas of opportunity. Develop performance analysis and control systems that identify clients’ business inefficiencies and create solutions focused on healthcare administration cost savings. Conceptualize and recommend strategic platform enhancements resulting in additional healthcare administration operational efficiencies and cost reduction. Ensure product solutions and platform functionalities meet state and federal regulations and mandates. Drive the full lifecycle of project delivery: requirements gathering, configuration, testing and transitioning daily maintenance activities to the operations team. Support business development efforts through client engagement and system demonstrations as needed. Collaborate with the offshore quality assurance team regarding implementation testing and MOB, and track progress of test scripts and test case execution. Perform regular evaluations of, the Collaborative PBM Cloud™ platform user interface for client needs through quality assurance processes. Conceptualize management solutions based on research and analysis of claims data, conduct member disruption, and gap analysis. Develop SQL data queries for data analysis and validation and generate qualitative reports on Business Intelligence Tools (including but not limited to: Tableau, Kibana, etc.) with advanced visualization features. Interpret system data (pricing, claims, pharmacy, etc.) to formulate data-driven strategies and solutions for pharmacy network contracting, clinical programs, and formulary construction. Lead the creation of custom solutions based on reports and technical documentation to support system configuration, user training, and standard operating procedures. Monitor and review Medicaid, Medicare, Exchange, and other institutional policies to ensure platform compliance; if gaps are identified, work with technical and clinical teams to translate the state or federal regulations into configurable solutions that mitigate migration risk. Facilitate individual and group sessions with client partners to determine requirements and operational needs. Provide post-implementation assistance to operations and production support teams. Perform in compliance with, the current PBM v2.2 URAC standards applicable to the position.
Worksite: Southborough, MA.
Send resume using Reference Code 4146 to: Aruna Wickremeratne, CRO & CAO, RxAdvance Corporation, 136 Turnpike Road, Southborough, MA 01772.