“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!
Essential Duties and Responsibilities include the following. Other duties may be assigned.
• Reviews configuration completed by the Configuration Analyst team.
Requires additional test scenarios to augment sub-standard test plans produced during unit testing, ensuring system claims processing accuracy and adherence with design requirements and best practices.
Works with business partners to validate the accuracy of benefit changes by performing non-standard testing of complex benefit
designs and reviewing and approving test claims produced by the Configuration Analyst during unit testing in a pre-production environment.
• Ensures consistent customer satisfaction by collaborating with client team counterparts, internal business partners and clients to ensure that business requirements for change requests are clearly understood, documented, communicated, tested, and delivered flawlessly.
This is achieved through up-front clarification of specifications, design reviews, validation audits of existing configurations, development of best practice coding guidelines, appropriate documentation of review activities
including client specifications, expected outcomes, testing methodology & processes, unit level test results, recommendations, version control, and configuration design.
• Analyzes claims adjudication results and identifies discrepancies, inaccuracies, anomalies, and unintended consequences.
Makes recommendations and develops solutions to enhance the accuracy
of configuration designs.
• Confirms accuracy of adjudication configurations and approves changes from the test environment to the production environment, adhering to unit procedural and quality standards and independent judgment.
• Presents test claim results to clients through WebEx demonstrations, when necessary.
• Documents the accuracy of design, configuration, and unit test plans through the Accuracy Scorecard within Salesforce, enabling the tracking of department and individual performance to identify training opportunities or process improvement measures. Completes special projects and assignments as
assigned.
• Assists with pre-Assessment and configuration of change requests and answering client research questions when needed.
• Provides support to Sr. Testing and Validation Analysts as well as Lead Testing and Validation Analyst.
Supervisory Responsibilities
This job 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 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 (B.A.) from four-year College or university or a minimum of four (4) years related experience and/or training; or equivalent combination of education and experience. Previous healthcare or
PBM experience required. Experience with pharmacy or medical claims analysis required.
Computer Skills
Intermediate to advanced knowledge of MS Office / Word, Excel PowerPoint, and Outlook. Experience as an intermediate user of multiple business software applications and working knowledge of key technical
applications such as SQL, Oracle based platforms, and Golden 32. The ability to run SQL queries and scripts required.
Certificates, Licenses, Registrations
Pharmacy Technician License or National Certification helpful. Passing score of the intermediate level Excel based administered test.
Other Skills and Abilities Ability to gather and document business requirements and client specifications. Ability to develop, execute
and document test plans as part of quality assurance/control processes and procedures. Demonstrated ability to positively interact with clients, internal customers and peers. Demonstrated willingness to take
accountability for achieving service commitments and a demonstrated ability to achieve results. Demonstrates ability to appear for work on time, follow directions from a supervisor, interact well with coworkers, understand and follow work rules and procedures, comply with corporate policies, goals and
objectives, accept constructive criticism, establish goals and objectives, and exhibit initiative and commitment.
Reasoning Ability
Ability to solve practical problems and deal with a variety of concrete variables in situations where only
limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram,
or schedule form.
Mathematical Skills
Ability to work with mathematical concepts such as probability and statistical inference. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
Language Skills
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers,
clients, customers, and the general public.
Competencies
To perform the job successfully, an individual should demonstrate the following competencies:
Business Knowledge - Demonstrates clear understanding of the nature of the business -- its products
and services, goals, market, competitors and challenges.
Customer and Quality Focus - Actively demonstrates a personal concern for understanding client
needs, ensuring the quality of products and services, maintains a high level of customer satisfaction,
and contributes to continuous improvement of products and processes.
Responsiveness - Responds promptly, appropriately and effectively to requests, feedback and new
developments, making sure that all relevant concerns and requirements are understood and
addressed.
Problem Solving - Analyzes problems logically to identify root causes, seeks input from a wide range
of sources, asks insightful questions and formulates effective solutions.
Communication - Expresses self clearly and effectively in face-to-face interactions, presentations and
written documents, and employs active listening skills to ensure productive interactions.
Time Management - Plans effectively to meet target deadlines, foresees delays and responds
proactively, sets realistic timetables, utilizes time efficiently, and completes projects on time.
Interpersonal Effectiveness - Demonstrates good people skills by showing a commitment to
teamwork, resolving conflicts effectively and with respect for others’ viewpoints, respecting differences
and building strong relationships and networks.
Initiative - Proactively gathers and analyzes information, assesses situations and identifies challenges
and opportunities, sees what needs to be done and takes appropriate action.
Adaptability - Adjusts quickly to evolving situations by integrating new information, remaining flexible,
recognizing and implementing necessary changes and taking advantage of opportunities presented by
new developments.
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 05 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.
While performing the duties of this Job, the employee is in an office setting and is exposed to moderate
noise (examples: business office with computers and printers, light traffic).
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 8:00 AM to 5:00 PM.
Travel
This position may require travel up to 5% of the time. Also, attendance maybe required at various local training sessions and/or meetings
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.
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.
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.
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