Job Description
**Resp & Qualifications**
**PURPOSE:**
The Senior Business Analyst supports critical Medicare pharmacy business through advanced data analysis, reporting, and operational PBM oversight. This role interprets complex data to develop reports and presentations, ensures compliance with contractual and regulatory requirements, and supports quality and performance objectives across pharmacy operations.
**ESSENTIAL FUNCTIONS:**
_Pharmacy Operational & Analytical Functions_
+ Analyze pharmacy operational data and claims activity to identify trends, risks, and improvement opportunities.
+ Monitor claims processing and review pharmacy benefit coding for accuracy and compliance.
+ Perform prescription drug event (PDE) review, correction, and retraction activities.
_Medicare Regulatory & Compliance Functions_
+ Review and analyze monthly, quarterly, and annual data related to coverage determinations, redeterminations, and grievances.
**PURPOSE:**
The Senior Business Analyst supports critical Medicare pharmacy business through advanced data analysis, reporting, and operational PBM oversight. This role interprets complex data to develop reports and presentations, ensures compliance with contractual and regulatory requirements, and supports quality and performance objectives across pharmacy operations.
**ESSENTIAL FUNCTIONS:**
_Pharmacy Operational & Analytical Functions_
+ Analyze pharmacy operational data and claims activity to identify trends, risks, and improvement opportunities.
+ Monitor claims processing and review pharmacy benefit coding for accuracy and compliance.
+ Perform prescription drug event (PDE) review, correction, and retraction activities.
_Medicare Regulatory & Compliance Functions_
+ Review and analyze monthly, quarterly, and annual data related to coverage determinations, redeterminations, and grievances.
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