EmblemHealth

Compensation

Full Description

Summary Of Position Partner with Government Program manager to successfully drive implementations. Manage teams performing overall day to day operations for file system transfers, including eligibility, benefits, and system integration for claims processing, auth processing, etc., as well as post claim edit processes, such as appeals. Oversee project scope and submissions across systems, operations, maintenance, and enhancements. Serve as pharmacy systems subject matter expert including business requirement definition, test scenario definition, test review and approval UAT as appropriate. Serve as liaison between IT and any key stakeholders/Pharmacy Benefits Management (PBM) vendor, pharmacy systems or other systems owners. Build project charters, project plans, risk/issue management tools to support flawless development and implementation of pharmacy projects Principal Accountabilities • Serve as liaison and subject matter expert among key stakeholders including PBM, IT and other vendor partnerships. • Identify system issues, working closely with all to define change and work towards acceptance and implementation. • Evaluate and solicit feedback on processes and procedures to identify potential areas for improvement. • Work with business units to develop test strategies and scenarios from business requirements. • Accurately interpret and translate strategies and scenarios into test plans. • Analyze requirements, test documents and acceptance criteria to effectively find and resolve gaps or defects. • Act as subject matter expert for day-to-day pharmacy system-related, technical questions and/or issues. • Troubleshoot and track issues, working with key stakeholders, and respond effectively within a timely manner. • Serve as the Pharmacy Systems Project Manager to support external and internal business partners. • Coordinate and direct project efforts, by providing a weekly written progress report to management updating the status of deliverables, issues, problems and corrective actions taken. • Provide written progress reports to leadership regarding the status of deliverables, issues, problems and corrective actions taken. • Define, gather, review and edit business requirements for system updates, enhancements and migrations. • Perform solution analysis review and provide concise direction to ensure that the proposed system solutions meet established business protocols, and any mandates and compliance guidelines. • Partner with business analysts, business users and source system experts to produce output, consistent with meeting overall goals. Qualifications • Bachelor’s degree required • 5 – 8+ years of related experience, preferably in a healthcare environment • Pharmacy Knowledge • Extensive knowledge and experience in Microsoft Office, specifically Access, Excel and Word, SAS • Ability to manage all project documentation for presentation and reporting (business requirements, test packet, status and prioritization for a variety of audiences including Senior Management, Care Management, Pharmacy Services and CM Data Systems customers) • Ability to understand complex technical system requirements and translate into simple business language • Excellent communication skills (verbal, written, presentation, interpersonal) with all types/levels of audiences • Outstanding attention to detail; ability to think critically and problem solve Additional Information • Requisition ID: 1000002701 • Hiring Range: $77,760-$149,040