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Independent, Transparent, Flexible.
Prescription Drug Event Analyst I
Location
United States
Posted
11 days ago
Salary
$22 - $35 / hour
Seniority
Junior
Job Description
Prescription Drug Event Analyst I
MedImpact Healthcare Systems, Inc.
• 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 in customer conference calls as the subject matter expert presenting and clarifying Medicare Part D claims data.
Job Requirements
- BS/BA and 1+ years’ experience or equivalent combination of education and experience
- 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.
Benefits
- 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
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