Description
We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.
This position is responsible for reviewing claims and PDE (Prescription Drug Event) errors. This includes analyzing and distributing the PDE Rejections reports and analysis to internal and external clients.
The position will serve as liaison between the PDE Reporting Team, PDE Eligibility/Reconciliation and all entities involved directly or indirectly with PDE to ensure timely and accurate resolution of PDE Rejections.
Responsibilities:
- Download and review the Acumen Outliers.
- Coordinate the research with various departments and submit the responses to external clients or Acumen according to CMS deadlines.
- Assist with the weekly PDE meetings.
- Ensure continuous improvement of Medicare claims data through root cause and impact analysis of errors, recommendations for systems and procedure enhancements.
Requirements:
- 3 years minimum experience with government-regulated health programs within financial operations and/or related experience (Medicaid, Medicare, and/or Exchanges).
- Working knowledge of Part D plans and ability to study and correctly interpret CMS Guidance.
- Review of guidance and being compliant with CMS.
Preferred Qualifications:
- Excellent written and verbal communication skills for interaction with clients, internal partners, and government agencies.
- Strong organizational skills and ability to manage multiple projects simultaneously.
- Excellent time management skills as these requests are time sensitive.
- Proficiency with Microsoft Word and Excel.
- Proficiency with SQL and/or Python.
Education:
- Bachelor's degree preferred or equivalent work experience required.
Benefits:
- Medical, dental, and vision coverage.
- Paid time off.
- Retirement savings options.
- Wellness programs.
Salary: $46,988.00 - $112,200.00 per year