Prescription Drug Event Analyst I

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MedImpact Healthcare Systems, Inc.

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1988

⚕️ Healthcare Insurance

💊 Pharmaceuticals

☁️ SaaS

💰 $1.4M Seed Round on 2013-09

Healthcare Insurance • Pharmaceuticals • SaaS

MedImpact Healthcare Systems, Inc. is a pharmacy benefit manager that works with health plans to make pharmacy benefits more accessible and affordable for members. The company serves over 20 million members and handles more than $40 billion annually in pharmacy transactions. MedImpact provides a variety of services including medication reminders, home delivery, and more to empower individuals to manage their prescriptions effectively. By leveraging technology and resources, MedImpact aims to offer a better choice within the pharmacy benefits market and supports health solutions in ensuring convenient and reliable access to medications for its members.

📋 Description

• 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.

🎯 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