Prescription Drug Analyst I

Prescription Drug Event Analyst I

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!

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. 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

Other Skills and Abilities

Reasoning Ability

Mathematical Skills

Language Skills

Competencies To perform the job successfully, an individual should demonstrate the following competencies :

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 maybe required at various local conferences and meetings.

The Perks :