PDE Analyst I

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

$44,470 - $57,803 - $71,136

“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

Summary: The Prescription Drug Event Analyst I is responsible for the analysis, calculation, and validation of the Medicare Prescription Drug Event (PDE) files for MedImpact clients.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• 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.

Supervisory Responsibilities

This position has no supervisory responsibilities

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.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below 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.

Education and/or Experience

Bachelor’s degree (or equivalent combination of education and experience) along with 2+ years’ related experience working with Medicare insurance or programs, in a managed healthcare setting, or a regulatory agency required. PBM industry experience a plus.

Computer Skills

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

Certifications

Certified Pharmacy Technician license, desired, not required

Other Skills and Abilities

• Understanding of claim processing concepts.
• Ability to prioritize urgent issues effectively.

• Possess 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.

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. 

Competencies

To perform the job successfully, an individual should demonstrate the following competencies:

• Problem Solving – Analyzes problems logically to identify root causes, seeks input from a wide range of sources, asks insightful questions and formulates effective solutions.

• Time Management – Plans effectively to meet target deadlines, foresees delays and responds proactively, sets realistic timetables, utilizes time efficiently, and completes projects on time.

• Prioritization – Accurately analyzes situations, identifies important issues and focuses the appropriate amount of attention, time and resources on those issues.

• Teamwork – Functions as a valuable team member by engaging in collaborative decision making and problem solving, constantly contributes positively as a team member, shares credit when appropriate and encourages teammates to use their knowledge and skills.

Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit and talk or hear. The employee is frequently required to use hands to finger, handle, or feel and reach with hands and arms. The employee is occasionally required to stand; walk and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.

Work Location

This position must work on-site at the San Diego Headquarters for purposes of providing adequate support to internal clients; being available for face-to-face interactions and coordination of work with other employees, colleagues, clients, or vendors; as well as for facilitation of quick and effective decisions through collaboration with stakeholders. Periodic scheduled remote work may be permitted as allowed under the department’s policy and with management approval. 

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.

Travel - This position requires no travel; however, attendance may be required at various local conferences and meetings.

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/VeteransOSHA/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.