MedImpact Healthcare Systems, Inc.
Prescription Drug Analyst I
MedImpact Healthcare Systems, Inc., San Diego, California, United States, 92189
### Exemption Status:United States of America (Non-Exempt)### $22.24 - $28.90 - $35.57“Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors.
A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate.”This position is not eligible for Sponsorship.MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team!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!# **Job Description****Summary**The Prescription Drug Event (PDE) Analyst I 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.**Essential Duties and Responsibilities** include the following. Other duties may be assigned.* 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.* 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.* Responsible for the establishment and maintenance 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.**Supervisory Responsibilities**No supervisory responsibilities
**Client Responsibilities**This is an internal and external client facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written).
One must be able to; manage difficult or emotional client situations; Respond promptly to client needs; Solicit client feedback to improve service; Respond to requests for service and assistance from clients; Meet commitments to clients.**Qualifications**To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.**Education and/or Experience**BS/BA and 1+ years’ experience or equivalent combination of education and experience**Computer Skills**Excel**Certificates, Licenses, Registrations**None required**Other Skills and Abilities*** 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.* Knowledge of healthcare operating systems preferred.* Insert skills and abilities**Reasoning Ability**
* 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.**Mathematical Skills**
* 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.**Language Skills*** 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.**Competencies** To perform the job successfully, an individual should demonstrate the following competencies:ComposureDecision QualityOrganizational AgilityProblem SolvingCustomer FocusDrive for ResultsPeer RelationsTime ManagementDealing with AmbiguityLearning on the FlyPolitical Savvy**Physical Demands**The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.While performing the duties of this Job, the employee is regularly required to sit and talk or hear. The employee is regularly required to stand; walk; use hands to finger, handle, or feel and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds.**Work** **Environment**The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.This position may regularly be exposed to or encounter moving mechanical parts, high, precarious places, fumes or airborne particles, toxic or caustic chemicals, outdoor weather conditions, risk of electrical shock or vibration. The noise level in the work environment is usually moderate (examples: business office with computers and printers, light traffic).**Work Location**This position works on-site at the San Diego Headquarters or other company location (or from a remote location with management #J-18808-Ljbffr
A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate.”This position is not eligible for Sponsorship.MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team!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!# **Job Description****Summary**The Prescription Drug Event (PDE) Analyst I 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.**Essential Duties and Responsibilities** include the following. Other duties may be assigned.* 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.* 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.* Responsible for the establishment and maintenance 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.**Supervisory Responsibilities**No supervisory responsibilities
**Client Responsibilities**This is an internal and external client facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written).
One must be able to; manage difficult or emotional client situations; Respond promptly to client needs; Solicit client feedback to improve service; Respond to requests for service and assistance from clients; Meet commitments to clients.**Qualifications**To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.**Education and/or Experience**BS/BA and 1+ years’ experience or equivalent combination of education and experience**Computer Skills**Excel**Certificates, Licenses, Registrations**None required**Other Skills and Abilities*** 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.* Knowledge of healthcare operating systems preferred.* Insert skills and abilities**Reasoning Ability**
* 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.**Mathematical Skills**
* 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.**Language Skills*** 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.**Competencies** To perform the job successfully, an individual should demonstrate the following competencies:ComposureDecision QualityOrganizational AgilityProblem SolvingCustomer FocusDrive for ResultsPeer RelationsTime ManagementDealing with AmbiguityLearning on the FlyPolitical Savvy**Physical Demands**The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.While performing the duties of this Job, the employee is regularly required to sit and talk or hear. The employee is regularly required to stand; walk; use hands to finger, handle, or feel and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds.**Work** **Environment**The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.This position may regularly be exposed to or encounter moving mechanical parts, high, precarious places, fumes or airborne particles, toxic or caustic chemicals, outdoor weather conditions, risk of electrical shock or vibration. The noise level in the work environment is usually moderate (examples: business office with computers and printers, light traffic).**Work Location**This position works on-site at the San Diego Headquarters or other company location (or from a remote location with management #J-18808-Ljbffr