Pharmacy Operations Analyst

Viva-Health; Birmingham (AL); Hybrid; USD 65,000 - 95,000; Full time

Benefits offered by this job

Health Coverage

401(k) Plan

Paid Time Off

Holidays & Floating Holiday

Tuition Assistance

Flexible Spending Accounts

Wellness Program

Training & Development

On-site office & collaboration

Job summary

VIVA HEALTH in Birmingham, AL is seeking a Pharmacy Operations Analyst to manage daily PBM-related tasks, monitor claims, and ensure compliance with pharmacy regulations. You will collaborate with PBMs to maintain benefits and resolve payment issues.

The role supports audit activities, generates routine dashboards, tracks eligibility and performance metrics, and communicates findings to management. A bachelor's degree and 5-7 years in health plan or PBM workflows are required.

Qualifications

• Bachelor's degree or equivalent experience required.
• 5–7 years with a Health Plan or PBM experience.
• Strong communication and analytics skills.
• Proficient in Microsoft Office; Power Query experience preferred.

Responsibilities

• Oversee daily PBM monitoring and claims issue tracking.
• Coordinate with PBMs to update benefits and research payment anomalies.
• Maintain compliance with pharmacy regulations and PDE/FIR reporting.
• Create and review operational dashboards to measure KPIs.
• Assist with audits and resolution of member/provider escalations.

Skills

Interpersonal skills

Critical thinking

Public speaking

Analytical abilities

Power Query

Education

Bachelor's degree or equivalent experience

Tools

Access

Word

Excel

PowerPoint

Job description

Bham-Corporate Office
Birmingham, AL 35203, USA

Description

Pharmacy Operations Analyst

Location: Birmingham, AL

Work Schedule: Hybrid schedule with regular work onsite at the VIVA HEALTH corporate office and some work-from-home opportunities.

Job Summary

The Pharmacy Operations Analyst is responsible for the daily tasks, functions, monitoring, and reporting related to pharmacy benefit administration for the Commercial and Medicare lines of business. This role is responsible for collaborating with the Pharmacy Benefit Manager(s) (PBM) to maintain and update pharmacy benefits, research and manage claims payment anomalies and inquiries, and maintain processes required to support accurate claims payment and compliance with pharmacy related regulatory requirements.

This position works with the Operations team to resolve pharmacy-related member and provider escalations and general pharmacy related issues.

Why VIVA HEALTH?

VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.

VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.

• Comprehensive Health, Vision, and Dental Coverage
• 401(k) Savings Plan with company match and immediate vesting
• Paid Time Off (PTO)
• 9 Paid Holidays annually plus a Floating Holiday to use as you choose
• Tuition Assistance
• Flexible Spending Accounts
• Community Service Time Off
• Life Insurance and Disability Coverage
• Employee Wellness Program
• Training and Development Programs to develop new skills and reach career goals
• Perform operational monitoring of the PBM, including claims issue tracking, eligibility file monitoring, error identification and follow-up, accumulation file validation, and operational support ticket tracking.
• Perform functions and tasks related to required reporting, including Prescription Drug Event (PDE) acceptance rate, claim reject reporting, hospice and End Stage Renal Disease (ESRD) reporting, and Financial Information Reporting (FIR).
• Routine operational dashboard creation to monitor key performance indicators to analyze task-related effectiveness and opportunities for increased efficiency.
• Monitor and track metrics and markers related to member experience and work with management to identify strategies that could lead to improved member experience.
• Collaborate with the Operations team and PBM account manager to implement strategic initiatives and projects, assess accuracy of benefit administration, track open issues log and trends. Support ongoing operational processes to maintain compliance with regulatory requirements.
• Support Operations team to handle escalated pharmacy related member and provider issues and inquiries.
• Maintain up to date documentation of operational processes and procedures, as well as assist with development of new processes and procedures.
• Participate in internal and external audit activities, that may include gathering documentation, collection of evidence, tracking log audits, and correction action monitoring.

REQUIRED:

• Bachelor's degree or equivalent experience
• 5 - 7 years’ experience with a Health Plan, Part D, Pharmaceutical Business, Pharmaceutical Industry, PBM, etc.
• Excellent interpersonal skills for frequent interaction with staff, other departments, management, providers, employer groups, and external vendors
• Excellent critical thinking and analytical abilities
• Access, Word, Excel, and PowerPoint at an intermediate skill level (Power Query)
• Excellent written and oral communication skills including public speaking

PREFERRED:

• Experience with a PBM or Pharmacy in a position that required understanding of pharmacy claims and drug reimbursement as it relates to health insurance

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.