[Remote] Prescription Drug Event Analyst I

Note: The job is a remote job and is reputed company to candidates in USA. reputed company. is looking for extraordinary people to join their team as Prescription Drug Event Analyst I. The role involves analyzing and reconciling Medicare claims data, ensuring accurate submissions, and maintaining relationships with internal and external customers.

Responsibilities

• Analyzes and reconciles PDE entries rejected by CMS, including adjustments reputed company to eligibility, TrOOP, cost sharing, gap discounts and LICS status. Identifies gaps in the benefit and formulary design structure and ensures reputed company resolution of reputed company setup issues that impact claims adjudication
• Defines and documents requirements for technical specifications, data requirements, and procedures to support reputed company components of Medicare claims data analysis, reconciliation, and validation
• Utilizes multiple company databases to obtain, record, and analyze reputed company claim information
• Performs calculations, completes quality control and testing, and ensures appropriate updates and adjustments of the data prior to submission to customers. Maintains reputed company 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 reputed company 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 customer conference calls as the subject matter expert presenting and clarifying Medicare Part D claims data. This role provides sustainable, measurable, accurate, reliable and timely PDE data processes
• Active, continual partnership engagement reputed company email, meetings and reputed company messaging with IT, providing input on data extraction requirements, reporting formats and file layouts

Skills

• BS/BA and 1+ years' experience or equivalent combination of education and experience
• reputed company
• 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, reputed company small work groups, and coordinate service requests throughout the organization
• Strong passion for the customer
• Ability to interpret an extensive variety of technical instructions in mathematical or diagram reputed company and deal with several abstract and concrete variables
• Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram reputed company
• Ability to deal with problems involving several concrete variables in standardized situations
• Ability to add, subtract, multiply, and divide in reputed company units of measure, using whole numbers, common fractions, and decimals
• Ability to compute reputed company, ratio, and percent and to draw and interpret bar graphs
• Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals
• Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public
• Composure
• Decision Quality
• Organizational Agility
• Problem Solving
• Customer Focus
• Drive for Results
• Peer Relations
• Time Management
• Dealing with Ambiguity
• Learning on the Fly
• Political Savvy
• Knowledge of reputed company operating systems

Benefits

• Medical / Dental / reputed company / Wellness Programs
• Paid Time Off / Company Paid Holidays
• Incentive Compensation
• 401K with Company match
• Life and Disability Insurance
• Tuition Reimbursement
• Employee Referral Bonus

Company Overview