Job Description

Awarded the Best Place to Work 2021, Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

This position is remote within the state of AZ only.  This remote work opportunity requires residency, and work to be performed, within the State of Arizona.

Responsible for a broad range of activities supporting aspects of the Blue Cross® Blue Shield® of Arizona Medicare pharmacy benefits and programs. This includes, but is not limited to, all Medicare Part D, Part B and stand-alone Prescription Drug Plan programs. 55

Responsible for internal and external support functions that contribute to all Medicare programs that BCBSAZ supports

REQUIRED QUALIFICATIONS

Required Work Experience

  • 1 year of experience as a PA technician internal or external to Blue Cross
  • 1 year of experience in a Medicare Advantage or PDP environment

Additional experience required:

Level 1

1 year Experience in Medicare pharmacy or medical field (eg pharmacy, health insurance, medical office, etc)

Level 2

2 years Experience in Medicare pharmacy or medical field (eg pharmacy, health insurance, medical office, etc)

1 year Experience in Medicare Pharmacy Prior Authorization Intake & Processing

Level  3

3 years Experience in Medicare pharmacy or medical field (eg pharmacy, health insurance, medical office, etc)

2 years Experience in Medicare Pharmacy Prior Authorization Intake & Processing

1 year Experience working on Specialty Pharmacy reviews including Medical Reviews

Level 4

10 years Experience in Medicare pharmacy or medical field (eg pharmacy, health insurance, medical office, etc)

4 years Experience in Medicare Pharmacy Prior Authorization Intake & Processing

2 years Experience working on Specialty Pharmacy reviews including Medical Reviews

Required Education

  • High school degree or GED

Required Licenses

  • AZ State Pharmacy Technician License and National Certification (CPhT)

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Required Certifications

  • N/A

PREFERRED QUALIFICATIONS

Preferred Work Experience

  • Previous experience in healthcare industry such as in a PBM (Pharmacy Benefit Manager)
  • Additional related education and/or experience preferred
  • Analytic experience a plus

Level 1

3 years Experience with a Medicare pharmacy benefit management  or prescription claim administration

1 year Experience in Medicare Prior Authorization

1 year Experience with the current BCBSAZ PBM system

2 years Demonstrated experience handling confidential information

Level 2

3 years Experience with a Medicare pharmacy benefit management  or prescription claim administration

2 years Experience in Medicare Prior Authorization

1 year Experience with the current BCBSAZ PBM system

3 years Demonstrated experience handling confidential information

Level 3

5 years Experience with a Medicare pharmacy benefit management  or prescription claim administration

3 years Experience in Medicare Prior Authorization

2 years Experience with the current BCBSAZ PBM system

1 year Experience with BCBSAZ claims software / systems Medical & Pharmacy

4 years Demonstrated experience handling confidential information

Level 4

12 years Experience with a Medicare pharmacy benefit management  or prescription claim administration

10 years Experience in Medicare Prior Authorization

3 years Experience with the current BCBSAZ PBM system

2 years Experience with BCBSAZ claims software / systems Medical & Pharmacy

10 years Demonstrated experience handling confidential information

Preferred Education

  • College degree  

Preferred Licenses

  • Current AZ BOP tech license

Preferred Certifications

  • Current CPhT license

ESSENTIAL job functions AND RESPONSIBILITIES

  • Support vendor oversight activity that ensures compliance related to pharmacy claims, coverage determinations, part D accumulators, EOB accuracy, paper claims, pharmacy access monitoring, and reporting on all oversight
  • Support Medicare Quality and STAR measure improvement, which may include direct interface with Medicare members, and network providers concerning pharmacy issues, audits and programs as required
  • Support compliance activities such as, fraud, waste and abuse, internal audits, and CMS program audits
  • Maintain productivity standards for internal program support and outreach activities
  • Provide process improvement recommendations that drive improved quality, CMS compliance and operational success
  • Incorporate quality improvement principles into other activities and projects (i.e. data collection, documentation)
  • Strategically contribute to departmental initiatives
  • Generate required internal and external reporting with high quality accuracy.  Provide summary reports to department and divisional leadership as well as required reporting for corporate and external executives.
  • Develop and maintains relationships with business partners to develop short and long term strategies on the advancement of Medicare programs
  • Work with internal and vendor based analytic platforms to run and/or create and analyze all points of data for reporting purposes
  • Perform all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards
  • Provide all customers with an excellent service experience by consistently demonstrating core and leader behaviors every day
  • The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
  • Extensive sitting with periodic standing and walking
  • Significant use of personal computer, phone and general office equipment
  • Ability to communicate effectively through reading, writing, and speaking in person or on telephone 
  • May require off-site travel
  • Perform all other duties as assigned

competencies

REQUIRED COMPETENCIES

Required Job Skills

  • Intermediate PC proficiency with word processing, spreadsheets, and claims and imaging software
  • Ability to lift up to 20 pounds

Required Professional Competencies

  • Ability to develop relationships with internal and external customers
  • Strong interpersonal skills are required.
  • Able to communicate effectively
  • Compose a variety of business correspondence

Required Leadership Experience and Competencies

  • Make use of employees' skills and abilities to deliver business objectives
  • Use available information to focus the team's activities and identify priorities

PREFERRED COMPETENCIES

Preferred Job Skills

  • Advanced PC proficiency with word processing, spreadsheets, and claims and imaging software
  • Bilingual in Spanish

Preferred Professional Competencies

  • Effective interpersonal communication
  • Multicultural sensitivity
  • Claim system experience with pharmacy vendor software and/or systems

Preferred Leadership Experience and Competencies

  • Account team experience

Our Commitment

BCBSAZ does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona.  For more information on our company, see azblue.com.  If interested in this position, please apply.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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