Job Description :
Job Description:



Requirements:
Demonstrated Working experience in Payer-PBM interfaces (few key entities from Pharmacy/PBM spectrum)
Member Eligibility
Product/Benefit
Claim Processing
Prior Authorization
Formulary
Consumer/Member portals & Mobility applications
Medicare/Medicaid, PDE, Encounter
Coordination of Benefits
NCPDP layout and EDI Rx transactions
Specialty Pharmacy
Mail order Pharmacy
Excellent knowledge in Elicitation of Business requirements by collaborating with Business sponsors
Efficient in translating Business Requirements into Functional and Non-Functional Requirements
Strong communication skillset who can be engaged with business stakeholders as Pharmacy domain SME
Experienced in User Acceptance Testing (UAT)
Strong exposure to Agile and Waterfall - Model and tools (eg: JIRA, Confluence etc)
Good to have:
Working experience with PBM migration with any of the leading Payers (Anthem, Aetna, United etc)
Certified in Agile practices - SAFe® Practitioner, Scrum Master etc
Certifications in Business Analysis
PMP