Job Description

Short Description:

This position will be responsible for managing the relationship between the Division's pharmacy program and the system functionality that enforces the business rules and requirements specific to pharmacy operations within the Medicaid program.

Complete Description:

NC DHHS Division of Health Benefits is seeking a Business Systems Analyst.

This position will be responsible for managing the relationship between the Division's pharmacy program and the system functionality that enforces the business rules and requirements specific to pharmacy operations within the Medicaid program.

Job Specific Responsibilities

Monitor PHP data reports and identify issues

Research Pharmacy issues

Identify defects and track to resolution

Request system enhancements and track to resolution

Preferred Knowledge, Skills, and Abilities:

• Experience with Pharmacy claim adjudication
• Working knowledge of First Data Bank (FDB) drug classifications such as therapeutic drug classes, NDCs, GSNs, GCNs, etc.), drug dosage, packaging and pricing
• Understanding of Medicaid PDL (for generic and brand drugs), preferred/non-preferred drug, prior authorization criteria/rules, lock-in program requirements and drug utilization review (both ProDUR and RetroDUR).
• Experience with gathering requirements and interpreting business rules
• Demonstrated ability to work independently in a fast-paced environment with concurrent deadlines
• Excellent communication, negotiation, conflict resolution and persuasion abilities
• Strong organizational, time management, communication, and detail-oriented skills
• Highly proficient with Microsoft Outlook, Word and Excel