Navitus Health Solutions, LLC, owned by SSM Health and Costco Wholesale Corporation, was founded in 2003 as an alternative to traditional pharmacy benefit manager (PBM) models. Navitus approaches pharmacy services differently. We are purpose-driven to help humans and committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. We proudly serve over 14 million people through more than 800 plan sponsor and health plan client relationships. Our transparent, fully pass-through model enables our clients to achieve their goals and drive desired health and financial outcomes.

The Sr. Business Analyst provides business analysis support to the development, implementation, and maintenance of all products within the Fee For Service(FFS) Department. The Sr. Business Analyst will interact with key operating departments related to Fee For Service (FFS) Department business development and operational compliance. The Sr. Business Analyst also understands the roles and responsibilities of the business area and how it fits within the entire corporation. This individual develops an understanding of Government Programs regulations and related CMS and/or specific state guidance and is responsible for proactive review of all CMS and state regulations and guidance. The Sr. Business Analyst will lead special projects as necessary. The Sr. Business Analyst will develop and execute test scenarios/plans, coordinate the user/system testing and is responsible for quality assurance. The Sr. Business Analyst is proficient at data reporting and analysis using the standard tools for reporting at Navitus.

Is this you? Find out more below!

Responsibilities

How do I make an impact on my team?

• Becomes the Subject Matter Expert (SME) on all assigned processes
• Mentors Technical Operations Staff by training on eliciting and writing business requirements, testing techniques, interpreting guidance, implementing process improvements, managing a project, and the full Software Development Life Cycle (SDLC)
• Volunteers to take on projects outside of their assigned processes to help other Business Analysts as needed.
• Demonstrates leadership within Technical Operations and/or Government Programs
• Leads the Process Oversight Meetings to ensure process compliance and reliability for all assigned processes as Process Owner. Is a self-directed informal leader in ensuring appropriate action is taken through completion for process defects, non-compliance, and/or inefficiencies for assigned processes.
• Ensures technical process supporting government programs has the appropriate controls and oversight reporting and compliance with regulatory requirements on the end-to-end process. If process controls are absent, the expectation is to identify, define, and implement new ones as needed.
• Develops and maintains clear and concise documentation for all assigned processes using proficient Technical Writing skills. Maintains process support documentation that other stakeholders may utilize to understand the complex processes that make up the department.
• Identifies and documents business requirements for new Technical Operations processes and services, and changes to existing Technical Operations processes and services, as needed, to achieve department business goals.
• Identifies and manage changes to existing Technical Operations processes. This includes Scope Definition, Business Requirements, User Acceptance Testing, and Implementation.
• Establishes processes that are scalable and efficient and ensure smooth transition to operational maintenance by the Technical Operations Coordinators. Identifies key metrics to monitor the compliance and accuracy of the process, establishing oversight methods that are operationally efficient and effective. Provides SME assistance when process metrics indicate possible risk to compliance or accuracy and leads any corrective action required once diagnosed.
• Seeks opportunities to initiate and manage projects to improve existing processes delivering enhanced quality and efficiency.
• FFS roles will be required to perform system demonstrations and contribute to RFP activities.

What our team expects from you?

• Bachelor’s degree in business related field; or equivalent combined education and experience required
• 5+ years’ experience as a Business Analyst. Seeking a candidate who has proven technical capabilities and has successfully lead projects, wrote business requirements, administered major testing efforts, and implemented numerous process improvements
• FFS positions require NCPDP and prior claims experience
• Participate in, adhere to, and support compliance program objectives
• The ability to consistently interact cooperatively and respectfully with other employees