Network Data Analyst

Title: Network Data Analyst – Remote

Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.

Job Description Summary

Job Description

The Network Data Analyst is responsible for research and interpretation of network requirements necessary to support new and existing networks and product development. This position performs analysis related to proper network, pricing design and system requirements necessary for accurate claims processing, which includes maintenance of documents, process improvements, feasibility testing and quality audit.

Responsibilities

• Represent Network Operations and participate in large scale client facing projects, internal cross functional projects, and implementation interactions by providing insight, recommendations, and requirement gathering for Network Operations related items
• Review and execute escalated, new, revised, and non-standard network operations requests; determine applicable adjudication system set up to ensure claims sequencing is accurate based upon analysis and interpretation for all lines of business and channels (including , but not limited to Commercial, Medicare Part D, and Specialty Pharmacy programs
• Represent Network Operations by effectively communicating procedures, quality controls and addressing other related inquires during internal and external audits
• Guide multiple smaller but complex projects independently and/or assist Functional Business Consultant on complex projects. Projects will include large sets of data and analysis with tools such as Alteryx, AQT and SQL
• Perform complex quality reviews of large sets of data and analysis of cases to prevent errors based on strict compliance, service level agreements, and regulatory guidance
• Assist in the intake of new projects, business initiatives and process improvements; work directly with assigned business area and consult with various levels across organizations as needed.
• Create and deliver informal training for project and process improvements for successful and timely completion of work.
• Perform user acceptance testing at a feature level and present new features to users in individual or group settings
• Other duties as assigned

Minimum Qualifications

• Bachelor’s degree in IT, Business, Mathematics or related area of study, or equivalent combination of education and relevant work experience; HS diploma or GED required
• 2 years of work experience in network operations, pharmacy benefit management operations or and/or healthcare operations inclusive of experience manipulating large, complex data sets
• Must be eligible to work in the United States without need for work visa or residency sponsorship

Additional Qualifications

• Effectively analyze information to resolve complex issues
• Experience working on client facing initiatives, projects, and issue resolution
• Organizational skills with ability to work on multiple projects simultaneously under strict timelines
• Ability to drive results with strong commitment toward continuous process improvement and customer service.
• Proficient in Microsoft Word, Microsoft Access, Alteryx, and Excel.
• Knowledge of AS400 or other claim adjudication system(s), query tools and advanced Excel functions
• Self Starter with leadership abilities

Preferred Qualifications

• 2 years of work experience in pharmacy benefit design, claims processing, or Pharmacy Benefit Management (PBM)

Minimum Physical Job Requirements

• Ability to work a flexible schedule including shifts outside of Prime’s core business hours of 9:00 a.m. to 3:00 p.m.
• Constantly required to sit, use hands to handle or feel, talk and hear
• Frequently required to reach with hands and arms
• Occasionally required to stand, walk and stoop, kneel, and crouch
• Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds
• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus

Reporting Structure

• Reports to a Supervisor or Manager in the PBM Operations department

Potential pay for this position ranges from $63,400.00 – $95,200.00 based on experience and skills. Pay range may vary by 8% depending on applicant location.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page (https://www.primetherapeutics.com/careers/benefits/) and click on the “Benefits at a glance” button for more detail.

Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law.

Positions will be posted for a minimum of five consecutive workdays.

Prime Therapeutics’ fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today’s health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.

If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people’s lives.

Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources