Analyst - PA Accel

March 26

🐻 Alaska – Remote

Although this job is listed in Alaska, this company may be open to hiring remote in other states.

🌺 Hawaii – Remote

Although this job is listed in Hawaii, this company may be open to hiring remote in other states.

+10 more states

🐻 Alaska – Remote 🌺 Hawaii – Remote 🦞 Maine – Remote 🗻 New Hampshire – Remote 🌶️ New Mexico – Remote 🎸 Mississippi – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote ⚔️ Virginia – Remote ⛰️ West Virginia – Remote 🦬 Wyoming – Remote

💵 $55.2k - $66.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

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Microsoft 365

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Microsoft 365 is a cloud-based suite of productivity applications designed for individuals, families, businesses, and educational institutions. It includes popular tools such as Word, Excel, PowerPoint, Outlook, and Teams, providing users with the ability to create, collaborate, and share documents and data seamlessly across devices. Microsoft 365 enhances productivity with features like Microsoft Copilot, which integrates AI capabilities to assist users in their everyday tasks, ensuring secure storage and organization of files while facilitating effective teamwork and communication.

10,000+ employees

🤝 B2B

👥 B2C

☁️ SaaS

📋 Description

• Prepare analyses and work orders for pharmacy drug prior authorization criteria sets, which can be configured in our automated prior authorization system. • Completes scheduled and urgent Prior Authorization criteria additions, terminations, and changes timely and accurately to prevent member access to care issues, missed performance guarantees and potential liquidated damages. • Performs quality assurance peer reviews and uses sound business judgment and expertise to contribute toward the creation of root cause analysis of issues. • Conducts system enhancement and regression testing of a low to moderate level of complexity for benefit configuration processes to ensure compliance with state, federal and client regulations/standards. • Analyze and report on program specific data associated with PA Accel. • Ensure automated prior authorization continues to function as intended and is scalable to Navitus’ clients. • Coordinate enhancement efforts with Product Manager, and aid in user tests as they are implemented. • Onboard new and existing clients onto the automated PA platform. • Complies with standards set forth regarding automated Prior Authorization benefit design and configuration including HIPAA, NCPDP and Navitus internal business standards. • Be an internal point of contact on this product and work with cross-functional teams to audit, implement, enhance, train, and explain the benefits of the product.

🎯 Requirements

• A minimum of a Bachelor's Degree in a science, business, or mathematics related field, or at least four years of equivalent work experience is required • Experience with Prior Authorization and/or reporting and a “track record” of tangible success, and team collaboration/relationship-building/management is essential • Must be able to exercise appropriate judgment • Intermediate experience with Excel required • Experience with pharmacy prior authorization or PBM knowledge preferred • Participate in, adhere to, and support compliance program objectives • The ability to consistently interact cooperatively and respectfully with other employees

🏖️ Benefits

• Top of the industry benefits for Health, Dental, and Vision insurance • 20 days paid time off • 4 weeks paid parental leave • 9 paid holidays • 401K company match of up to 5% - No vesting requirement • Adoption Assistance Program • Flexible Spending Account • Educational Assistance Plan and Professional Membership assistance • Referral Bonus Program – up to $750!