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.

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.

Prescription Drug Event Analyst II

About this role