Prescription Drug Event Analyst II
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Job Description
Prescription Drug Event Analyst II at MedImpact, analyzing and validating Medicare Prescription Drug Event files. Collaborating with clients to ensure timely and accurate submissions of claims data.
Responsibilities:
- 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
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