Prescription Drug Event Analyst II

MedImpact•San Diego, CA

14d•$25 - $41•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 Prescription Drug Event Analyst II is responsible for the prompt analysis, calculation, reconciliation, and validation of the Medicare Prescription Drug Event (PDE) files for MedImpact customers. This position serves as a subject matter expert for Medicare prescription drug adjudication data and interfaces with MedImpact customers and internal staff to ensure timely and accurate PDE file submissions. Position requires technically complex analysis and a high degree of accuracy, carrying with it significant consequence of error for the organization and MedImpact customers. Additionally, the PDE Analyst II is a proactive training role which assists the GPS Operations Supervisor in training and engaging IT or additional resources for PDE issues.

Requirements

BS/BA and 2+ years’ experience or equivalent combination of education and experience
Excel, SQL
Detailed understanding of claim processing concepts.
Ability to prioritize urgent issues effectively.
Outstanding numeric, verbal, written, logic and analytical skills.
Understanding of basic financial concepts.
Detail oriented with a high degree of accuracy & follow through.
Self-starter with the ability to work independently & as part of a team
Ability to influence others, lead small work groups, and coordinate service requests throughout the organization.
Strong passion for the customer.
Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.
Ability to deal with problems involving several concrete variables in standardized situations.
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 and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
Composure
Decision Quality
Organizational Agility
Problem Solving
Customer Focus
Drive for Results
Peer Relations
Time Management
Dealing with Ambiguity
Learning on the Fly
Political Savvy

Nice To Haves

Knowledge of healthcare operating systems preferred.

Responsibilities

Analyzes and reconciles PDE entries rejected by CMS, including adjustments related to eligibility, TrOOP, cost sharing, gap discounts and LICS status.
Identifies gaps in the benefit and formulary design structure and ensures prompt resolution of all setup issues that impact claims adjudication.
Identifies trends and markers of problematic claims data (global to the industry or to the specific plan), conducts root cause analysis (if applicable) and makes suggestions to management on possible resolutions.
Defines and documents requirements for technical specifications, data requirements, and procedures to support all components of Medicare claims data analysis, reconciliation, and validation
Utilizes multiple company databases to obtain, record, and analyze complex claim information; Performs calculations, completes quality control and testing, and ensures appropriate updates and adjustments of the data prior to submission to customers.
Maintains current understanding of customers' Medicare Part D coverage and benefit plans in order to accurately analyze and prepare Medicare claims data for transmission to customers.
Recommends improvement in workflow processes by suggesting procedural enhancements supporting timely and accurate PDE submissions.
Ensures continuous improvement of Medicare claims data through root cause analysis of errors, recommendations for systems and procedure enhancements, and education and training as appropriate.
Provides training to other GPS personnel on process improvements and updated workflow processes.
Assists less experienced team members on understanding the daily operations and the department’s standard operating procedures.
Responsible for the establishment and maintenance of a positive working relationship with both internal and external customers.
Participates customer conference calls as the subject matter expert presenting and clarifying Medicare Part D claims data.
This role provides sustainable, measurable, accurate, reliable and timely PDE data processes.
Active, continual partnership engagement via email, meetings and instant messaging with IT, providing input on data extraction requirements, reporting formats and file layouts.