MedImpact Healthcare Systems, Inc.
Prescription Drug Event Analyst I
MedImpact Healthcare Systems, Inc., San Diego, California, United States, 92189
Prescription Drug Event Analyst I
MedImpact Healthcare Systems, Inc.
Job Description The Prescription Drug Event 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.
Essential Duties and 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.
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 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.
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 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.
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
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
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 approval based on business requirements). Must provide adequate support to internal clients; be available for regular interactions and coordination of work with other employees, colleagues, clients, or vendors; as well as be available to facilitate effective decisions through collaboration with stakeholders.
Working Hours This is a full-time non-exempt position requiring one to be able to work overtime from time to time in order to get the job done. Therefore, one must have the ability to work nights, weekends or on holidays as required. This may be changed at any time to meet the needs of the business. The typical working hours for this position are Monday through Friday from 8:00am to 5:00pm.
Travel This position requires no travel however attendance may be required at various local conferences and meetings.
The Perks
Medical / Dental / Vision / Wellness Programs
Paid Time Off / Company Paid Holidays
Incentive Compensation
401K with Company match
Life and Disability Insurance
Tuition Reimbursement
Employee Referral Bonus
To explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to www.medimpact.com/careers
MedImpact is a privately‑held pharmacy benefit manager (PBM) headquartered in San Diego, California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high‑value solutions to payers, providers and consumers of healthcare in the U.S. and foreign markets.
Equal Opportunity Employer, Male/Female/Disabilities/Veterans
Disclaimer: The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.
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Job Description The Prescription Drug Event 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.
Essential Duties and 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.
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 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.
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 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.
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
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
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 approval based on business requirements). Must provide adequate support to internal clients; be available for regular interactions and coordination of work with other employees, colleagues, clients, or vendors; as well as be available to facilitate effective decisions through collaboration with stakeholders.
Working Hours This is a full-time non-exempt position requiring one to be able to work overtime from time to time in order to get the job done. Therefore, one must have the ability to work nights, weekends or on holidays as required. This may be changed at any time to meet the needs of the business. The typical working hours for this position are Monday through Friday from 8:00am to 5:00pm.
Travel This position requires no travel however attendance may be required at various local conferences and meetings.
The Perks
Medical / Dental / Vision / Wellness Programs
Paid Time Off / Company Paid Holidays
Incentive Compensation
401K with Company match
Life and Disability Insurance
Tuition Reimbursement
Employee Referral Bonus
To explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to www.medimpact.com/careers
MedImpact is a privately‑held pharmacy benefit manager (PBM) headquartered in San Diego, California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high‑value solutions to payers, providers and consumers of healthcare in the U.S. and foreign markets.
Equal Opportunity Employer, Male/Female/Disabilities/Veterans
Disclaimer: The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.
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