PBM Reporting Analyst at Genesis10
Minneapolis, MN 55440
About the Job
Job Description:
We are seeking PBM Reporting Analysts to manage and enhance our performance guarantee processes focused on Prior Authorization (PA) and Appeals. This role involves leading end-to-end business process improvement efforts, ensuring quality control, and maintaining compliance with audit requirements across the 19 states we serve. As a Senior Analyst, you will be a subject matter expert on regulatory and compliance standards, driving impactful process improvements and supporting quality management initiatives.
Key Responsibilities:
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Process Improvement: Diagnose and identify process improvement opportunities, develop solutions using process excellence tools, and implement enhancements to improve compliance and operational efficiency.
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Quality Assurance & Reporting: Perform quality analysis, reporting, and auditing to support continuous quality improvement. Develop programs to sustain performance, using tools and techniques applicable to Total Quality Management (TQM).
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TQM Program Management: Support the design, facilitation, training, and evaluation of TQM programs related to PA and Appeals. May lead quality improvement projects, fostering a high standard of compliance across teams.
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Regulatory Audit & Support: Serve as the regulatory expert for oversight and delegation audits, working with clients to ensure compliance with Prior Authorization and Appeals standards.
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Data Analysis & Clinical Review: Conduct data validation, quality control, and clinical reviews on all Department of Insurance inquiries. Ensure PA and Appeals processes align with current regulatory guidance and patient-specific requirements.
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Compliance & Root Cause Analysis: Analyze cases for non-compliance, conduct root cause analysis on untimely or inaccurate cases, and recommend improvements to maintain client relations and regulatory adherence.
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Process Improvement & Trend Analysis: Lead initiatives to identify process improvements, ensuring compliance with state and federal laws, contractual obligations, and regulatory requirements.
Qualifications:
- Experience in healthcare prior authorization or appeals processes
- Experience in the pharmacy benefit manager industry
- Strong analytical skills focused on data analysis and visualization for quality reporting, audit support, and root cause analysis.
If you have the described qualifications and are interested in this exciting opportunity, apply today!
Ranked a Top Staffing Firm in the U.S. by Staffing Industry Analysts for six consecutive years, Genesis10 puts thousands of consultants and employees to work across the United States every year in contract, contract-for-hire, and permanent placement roles. With more than 300 active clients, Genesis10 provides access to many of the Fortune 100 firms and a variety of mid-market organizations across the full spectrum of industry verticals.
Benefits of Working with Genesis10:
- Access to hundreds of clients, most who have been working with Genesis10 for 5-20+ years.
- The opportunity to have a career-home in Genesis10; many of our consultants have been working exclusively with Genesis10 for years.
- Access to an experienced, caring recruiting team (more than 7 years of experience, on average.)
- Behavioral Health Platform
- Medical, Dental, Vision
- Health Savings Account
- Voluntary Hospital Indemnity (Critical Illness & Accident)
- Voluntary Term Life Insurance
- 401K
- Sick Pay (for applicable states/municipalities)
- Commuter Benefits (Dallas, NYC, SF)
- Remote opportunities available
For multiple years running, Genesis10 has been recognized as a Top Staffing Firm in the U.S., as a Best Company for Work-Life Balance, as a Best Company for Career Growth, for Diversity, and for Leadership, amongst others. To learn more and to view all our available career opportunities, please visit us at our website.
Genesis10 is an Equal Opportunity Employer. Candidates will receive consideration without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
