Prescription Drug Event Analyst II

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.

Posted 3/29/2026full-timeRemote • California • 🇺🇸 United StatesJuniorMid-Level💰 $25 - $41 per hourWebsite

About the role

Key responsibilities & impact

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.
Identifies trends and markers of problematic claims data and conducts root cause analysis.
Defines and documents requirements for technical specifications, data requirements, and procedures for analysis, reconciliation, and validation.
Maintains current understanding of customers' Medicare Part D coverage and benefit plans for accurate data preparation.

Requirements

What you’ll need

BS/BA and 2+ 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
Knowledge of healthcare operating systems preferred.

Benefits

Comp & 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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

data analysisroot cause analysisclaims adjudicationtechnical specificationsdata requirementsreconciliationvalidationbenefit designformulary designMedicare Part D

Soft Skills

prioritizationnumeric skillsverbal skillswritten skillslogic skillsanalytical skills