Appeals & Grievances Implementation Specialist

MedImpact Healthcare Systems, Inc.•San Diego, CA

33d•Onsite

About The Position

MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team! Why join MedImpact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare. At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution! The Appeals & Grievances Implementation Specialist reports to the Appeals & Grievances Manager adhering to operational guidance at the direction of the Appeals & Grievances Supervisor and in collaboration with the Prior Authorization Implementation team. This position is responsible for: 1) Implementation of new Appeals and Grievances clients; 2) Maintenance of Business for process application updates as they relate to timers and notifications 3) Vendor Oversight monitoring; 4) Performance Guarantee tracking and oversight. This position is responsible for application configuration and testing of each client’s Appeal and/or Grievance program, interfacing with clients for requirements gathering, coordinating the implementation of Appeals & Grievances processes per regulatory requirements, and managing the creation and maintenance of all associated notifications. Must be able to work in teams and manage a project to meet deliverables of the project according to established timelines.

Requirements

BS/BA and 3+ years’ experience or equivalent combination of education and experience
Advanced knowledge of MS Office / Word, Excel PowerPoint, Visio, and Outlook. Experience as a user of multiple business software applications.
Current and unrestricted State Pharmacy Technician License required and/or National Pharmacy Technician certification preferred.
Strong interpersonal skills with the ability to establish and maintain effective business relationships with clients, all levels of employees, and in multiple departments.
Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.
Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.

Nice To Haves

Advance working knowledge of key business applications such as MedOptimize, MedAccess, and others as applicable to the role preferred but not required.
Strong preference given to experience with business process management and business rules management applications

Responsibilities

Coordinates client implementations and system conversions by working closely with IT services as well as with the Compliance department, Implementation department, Prior authorization department, Accreditation team, legal team, client team, and others as may be required.
Attends various MedImpact implementation meetings such as Implementation status meeting, individual client operations meetings, Implementation Questionnaire (IQ) review, compliance and regulatory meetings, and PA Implementation meetings as required to gather business requirements and share information on client delegation, MedImpact’s PA and Formulary program offerings.
Serves as subject matter expert on implementation activities and processes related to the MedImpact’s Appeals and Grievances products and services. Additionally serves as a Medical Affairs resource for related questions and/or inquiries from both internal and external customers.
Serves as the principal or supporting liaison between MedImpact Medical Affairs, Appeals and Grievances, and the client team during the implementation or conversion process.
Conducts internal processing platform configuration tasks for implementation and maintenance of business of Appeal and Grievance clients. This includes but is not limited to: client specific timers, letters, reason codes, HiTrust audits, and granting system access.
Demonstrates system tools to internal and external groups when necessary.
Responsible for monitoring and tracking vendor activities including productivity, quality, and reporting.
Maintains confidentiality of all member, provider, client and proprietary information.
Maintain, monitor, and report all information and data related to Performance Guarantees.
Maintains and exercises competency to perform transactions in relevant MedImpact systems.
Remains knowledgeable regarding company policies and procedures and current developments within operational departments.