SlateRx

Company Bio: Founded by industry pioneers, SlateRx provides simple and affordable pharmacy benefit programs to employer groups, unions, public sector groups, health systems, and other payers throughout the United States. As the industry’s only PBXTM, SlateRx is creating real value for plan sponsors on day one through purchasing scale and continued management via innovation and transparency. Our model is designed to improve an out-of-touch healthcare model to make pharmacy benefits simple and affordable for plan sponsors and members. Job Overview: As a Clinical Coordinator, you will be responsible for supporting the clinical functions of coverage determinations and appeals in accordance with the policies and practices of SlateRx, LLC. This position will be responsible for ensuring efficiency, accuracy, and timeliness in reviewing coverage determinations and appeals. Responsibilities: As a Clinical Coordinator, your key responsibilities will include: - Create case files and transcribe clinical documentation for coverage determination and appeal requests. - Research claim reject messaging associated with coverage determination and appeal requests for pharmacist review. - Contact prescriber offices to obtain additional information. - Configure authorized coverage determination and appeal outcomes in the adjudication system after completion of review and decision by the pharmacist or client. - Handle inbound phone calls from prescribers and members regarding coverage determinations. - Respond to routine inquiries and correspondence regarding coverage determinations and appeals with members, prescribers, and pharmacies as applicable. - Notify physicians, members, and other health professionals as applicable, of coverage determination request decisions. - Ensure timely and accurate processing of requests. - Maintain compliance with established protocols and regulations from governing and accrediting agencies.. - Perform miscellaneous job-related duties as assigned. Qualifications: To excel in this role, you should possess the following qualifications: - Knowledge in the healthcare, insurance or PBM industry. - Experience in pharmacy benefit management, coverage determination, appeals and grievance (CDAG) operational processes, and regulatory requirements. - Computer and typing proficiency. - Ability to adapt to a dynamic and fast-paced environment. - Motivated individual who is well-organized and able to work with minimal amount of supervision. Education: High school diploma or GED required; Bachelor’s degree strongly preferred. License Requirement: Current and valid Pharmacy Technician Certification, Licensure, or Registration is required. Job Benefits: Health, Dental, Vision, Life, 401k, Paid Time Off. Location: Remote

Position: Senior Business Intelligence Developer Company Bio: Founded by industry pioneers, SlateRx provides simple and affordable pharmacy benefit programs to employer groups, unions, public sector groups, health systems, and other payers throughout the United States. As the industry’s only PBXTM, SlateRx is creating real value for plan sponsors on day one through purchasing scale and continued management via innovation and transparency. Our model is designed to improve an out-of-touch healthcare model to make pharmacy benefits simple and affordable for plan sponsors and members. Job Overview: As the Senior Business Intelligence Developer, you will play a pivotal role in delivering innovative, high-quality solutions and actionable insights to our clients and business partners. You will be leveraging your expertise in translating complex healthcare data into clear, actionable intelligence for our diverse user base. Collaborating closely with cross-functional teams, you will drive the success of our organization, enhance member health outcomes, and contribute to the growth of our organization. Responsibilities: As Senior Business Intelligence Developer, your key responsibilities will include: - Reporting & Dashboard Development: Design, develop, and maintain insightful reports, interactive dashboards, and compelling visualizations using leading BI tools (e.g., Looker, Tableau, Power BI) for various stakeholders, including hospital providers, managed care organization operators, healthcare providers, and healthcare executives. - Data Analysis & Insights: Conduct deep-dive analyses on large, complex healthcare datasets to identify trends, opportunities, and areas for improvement related to patient outcomes, medical costs, financial performance, and operational efficiency. - SQL & Database Proficiency: Write complex, optimized raw SQL queries to extract, transform, and load data from various relational and non-relational databases, ensuring data accuracy and performance. - Healthcare Domain Expertise: Apply exceptional knowledge of healthcare metrics, statistics, HCC coding, DRG coding, and the operational intricacies of various commercial and government healthcare plans (e.g., Medicare, Medicaid, commercial payers) to contextualize data and generate relevant insights. - Data Structure Understanding: Leverage a strong understanding of how healthcare data is structured across different sources (e.g., claims, EMRs, clinical notes) to effectively integrate and analyze information. - Cross-Functional Collaboration: Partner seamlessly with data engineers, product managers, clinical experts, and executives to understand their analytical needs, deliver tailored solutions, and provide expert data interpretation. - Requirements Gathering: Lead sessions to define reporting and analytical requirements from business users, translating their needs into technical specifications and data models. - Quality Assurance: Implement robust data validation and quality assurance processes to ensure the accuracy and reliability of all reports and dashboards. - Technical Leadership: Provide guidance and mentorship on BI best practices, data visualization techniques, and analytical methodologies to junior analysts and cross-functional partners. - Hiring & Onboarding: Participate in interviewing and onboarding new team members, helping to grow a world-class data and BI organization. - Other duties as assigned. Qualifications: To excel in this role, you should possess the following qualifications: - 8+ years of deep, hands-on experience as a Business Intelligence Analyst, Data Analyst, or a similar role, with a strong focus on delivering actionable insights. - Exceptional knowledge of healthcare metrics and statistics, including an in-depth understanding of how various commercial and government healthcare plans operate. - Extreme proficiency with databases, including how to access them and the ability to write complex, raw SQL queries for data extraction and manipulation. - Mastery of various BI visualization tools, specifically Tableau. - Comprehensive understanding of how healthcare data is structured across different systems and formats. - Intimate knowledge of and ability to implement data validation, quality assurance, and testing strategies for BI deliverables. - Experience providing technical leadership and guidance, and thinking strategically and analytically to solve complex business problems. - Friendly communication skills and ability to work well in a diverse, cross-functional team setting. - Demonstrated experience working with many cross-functional partners (Product, Engineering, Clinical Teams, Executives). - Demonstrated experience leading the analytical vision and delivery plan for a business intelligence product or component. Preferred Qualifications - Strong actuarial background or related experience in risk assessment and financial modeling within healthcare. - Direct experience having worked at a health plan (commercial, Medicare Advantage, Medicaid, or self-funded employer plans). - Knowledge of various standard plan formats (e.g., X12, HL7, FHIR, custom payer feeds). - Experience with big data technologies and cloud data platforms (e.g., Google Cloud Platform, AWS, Snowflake, Databricks). - Proficiency in scripting languages like Python for data manipulation and automation. - Experience with statistical analysis and predictive modeling. Education: - Undergraduate bachelor’s degree, with record of strong academic performance in Computer Science, Actuarial Science, Statistics, or Economics preferred License Requirement: Job Benefits: Health, Dental, Vision, Life, 401k, Paid Time Off. Location: Remote