Prescription Drug Event Analyst II
MedImpact Healthcare Systems, Inc.
full-time
Posted on:
Location Type: Remote
Location: California • United States
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Salary
💰 $25 - $41 per hour
About the role
- 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
- 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
- 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
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
data analysisroot cause analysisclaims adjudicationtechnical specificationsdata requirementsreconciliationvalidationbenefit designformulary designMedicare Part D
Soft Skills
prioritizationnumeric skillsverbal skillswritten skillslogic skillsanalytical skills