Prescription Drug Event Analyst I - II-1

Exemption Status:
United States of America (Non-Exempt)

$50,668 - $66,497 - $82,326

"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!

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

Level I - $44,462 - $57,800 - $71,138

Level II - $50,667 - 66,500 - $82,333

PDE I
Oversees the end-to-end PDE file generation process for assigned clients to extract Medicare Part D information by running SQL queries from MedImpact databases to comply with CMS data format requirements. In addition to SQL queries, required activities include cycle generation, executing PDE load and extract programs, file quality control and file submissions to CMS or clients. Executes the retrieval and processing of CMS response files and analyzes the file results. Provides feedback to clients on file outcomes and edit resolutions.
Responds to client emails (requests may include: follow up, general inquiries, recommendations for edit resolutions, status of projects) and redirects non-PDE emails to the correct recipient or SME. Creates Salesforce (CRM) cases from client emails that involve other departments. Salesforce case generation includes such items as true-ups, external compliance issues, NDC set up issues, or errors at the claims level.
Establishes excellent working relationships with the Part D Sponsors (assigned Clients) to retain their business, ensures deliverables are met, issues are resolved as well as assisting Plans to meet their goals. As an active member of the client team, attends and participates on client calls to review PDE Cycles for assigned Plans and addresses PDE-related questions and concerns.
Works with internal departments (IT Application Developer, Operations Schedulers and the Client Business Analyst) to resolve client specific claims issues and recalculation of Service Requests. Creates Salesforce cases and monitors status updates through completion.
Triages and analyzes trends in recent PDE cycles to identify edits or issues. Identifies appropriate owners such as internal MedImpact department or the Plan (client) for handling of edits or issues. Creates Salesforce case for internal resolution or communicates issues to clients along with recommendations for resolution.
Runs established SQL queries, extracting data from relational databases and tables for purposes of edit resolution, audit support, issue identification and creates "impact analysis" reports for clients.
Participates in interdepartmental meetings and client conference calls as the point of contact for Medicare Part D PDE data.
Actively participates in department and inter-department related projects (new client implementation, global requests for enhancement [GRE] and others) and completes assigned activities within the prescribed time frame.
Maintains current understanding of assigned client's Medicare Part D coverage and benefit plans in order to analyze the accuracy of PDE records. Monitors claim activities to ensure inclusion of all appropriate PDE records, adjustments and deletions of the data, prior to submission to CMS.
PDE II

Oversees the end-to-end file generation process for assigned clients to extract Medicare Part D information by running, editing and creating SQL queries from MedImpact databases to comply with CMS data format requirements. In addition to SQL queries, required activities include cycle generation, executing PDE load and extract programs, file quality control and file submissions to CMS or clients. Executes the retrieval and processing of CMS response files and analyzes the file results. Provides feedback to clients on file outcomes and edit resolutions.
Responds to client emails (requests may include: follow up, general inquiries, recommendations for edit resolutions, status of projects) and redirects non-PDE emails to the correct recipient or SME. Creates Salesforce (CRM) cases from client emails that involve other departments. Salesforce case generation includes such items as true-ups, external compliance issues, NDC set up issues, or errors at the claims level.
Establishes excellent working relationships with the Part D Sponsors (assigned Clients) to retain their business, ensures deliverables are met, issues are resolved as well as assisting Plans to meet their goals. As an active member of the client team, attends and participates on client calls to review PDE Cycles for assigned Plans and addresses PDE-related questions and concerns.
Works with internal departments (IT Application Developer, Operations Schedulers and the Client Business Analyst) to resolve client specific claims issues and recalculation of Service Requests. Creates Salesforce cases and monitors status updates through completion.
Triages and analyzes trends in recent PDE cycles to identify edits or issues. Identifies appropriate owners such as internal MedImpact department or the Plan (client) for handling of edits or issues. Creates Salesforce case for internal resolution or communicates issues to clients along with recommendations for resolution.
Using knowledge of PDE reporting requirements, manages associated data fields and basic PDE calculations for all plan types and mapping rules to ensure proper data elements are in the correct file segments.
Modifies and runs established SQL queries, extracting data from relational databases and tables for purposes of edit resolution, audit support, issue identification and creates "impact analysis" reports for clients.
Participates in interdepartmental meetings and client conference calls as the point of contact for Medicare Part D PDE data.
Actively participates in department and inter-department related projects (new client implementation, global requests for enhancement [GRE] and others) and completes assigned activities within the prescribed time frame.
Identifies trends and markers of problematic claims data (global to the industry or to the specific plan), conducts root cause analysis (if applicable) and makes suggestions to management on possible resolutions.
Maintains current understanding of assigned client's Medicare Part D coverage and benefit plans in order to analyze the accuracy of PDE records. Monitors claim activities to ensure inclusion of all appropriate PDE records, adjustments and deletions of the data, prior to submission to CMS.
Provides training to other GPS personnel on process improvements and updated workflow processes. Assists less experienced team members on understanding the day to day operations and the department's standard operating procedures.

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 and mitigate 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.

Education and/or Experience

Bachelor's degree (or equivalent combination of education and experience) along with 5+ years' related experience working with Medicare insurance or programs, in a managed healthcare setting, or a regulatory agency required. PBM industry experience a plus.

Certifications

Certified Pharmacy Technician license, desired, not required

Computer Skills

Intermediate level expertise with MS Excel, MS Word and Outlook tools. High-level working knowledge of running, creating and editing queries (Golden and/or Oracle/SQL queries) required. Working knowledge of proprietary healthcare operating systems and software desired.

Other Skills and Abilities

Detailed understanding of claim processing concepts.
Ability to prioritize urgent issues effectively.
Should have numeric, verbal, written, logic and analytical skills.
Detail oriented with a high degree of accuracy and follow through.
Self-starter with the ability to work independently and as part of a team.
Ability to influence others, lead small work groups, and coordinate service requests throughout the organization.
Solid understanding of PDE reporting requirements including PDE file layout and the DDPS (Drug data processing system) response file layout.
Bilingual - English/Spanish speaking strongly preferred.
Laker Software/Pharmscreens Platform experience preferred.
Reasoning Ability

Ability to define problems, collects data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.

Mathematical Skills

Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages. Ability to apply concepts of basic algebra.

Language Skills

Ability to read and interpret documents such as procedural manuals, operating and maintenance instructions. Ability to write routine reports and correspondence. Ability to speak effectively before groups of clients or internal staff members.

Working Hours

This is a 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.

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
OSHA/ADA:

To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily. The requirements listed 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.

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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