Business Operations Testing Analyst

Exemption Status:

“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

• Provides technical support for Point of Service (POS) testing of new rates and pharmacy carrier edits to ensure accuracy and integrity of data prior to production

• Provides proactive client test plan design analysis that establishes further opportunities for ensuring the integrity of the benefit, pharmacy network, formulary and other edits applied to a client’s configuration for claims processing.

• Develops project plans, prioritize project tasks, and provide status updates on project progress.

• Works with business partners to develop and execute test plans for new client implementations, eligibility records, and benefit, group, & carrier linking.

• Analyzes claims adjudication results against requirements and identifies and reports discrepancies and inaccuracies. Makes recommendations and develops solutions to enhance the accuracy of POS system changes and configuration setups.

• Determines accuracy of adjudication configurations and approves data changes from the test environment to production

• Mentor and train team members and peers.

• Lead the Testing and Validation team in solving new and unexpected problems that arise during the implementation phase of the project

• Appropriately improves processes, open to suggestions and experimentation, interested in re-engineering only when measureable benefits can be gained.

• Determines length and difficulty of tasks and projects, assigns task/people and anticipates  problems or roadblocks.

• Serves as a subject matter expert for claims adjudication configurations and expected outcomes.

• Proactively seeks out opportunities to improve claims testing processes through technology and process improvement solutions.

• Develops efficient SQL queries to research, gather data and identify solutions.

• Provides consultative services to organizational quality initiatives and processes

• Advanced proficiency with key business applications such as MS Office tools, Golden 32 and others as applicable to the role.

• Ability to make sound and timely decisions, uses a mixture of analysis, experience, judgment and wisdom, sought out by others for solutions

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 from four-year college or university in computer science, business administration, management information systems, or closely related and four (4) or more years’ testing and validation experience in the healthcare industry with knowledge of pharmacy benefits and claims processing configurations; or equivalent combination of education and experience.

Computer Skills:

Advanced expertise is MS Office; Word, Excel, PowerPoint, Access and Outlook.  Working knowledge of Oracle, SQL, Visio, along with working knowledge of healthcare operating systems and MedImpact file layout specifications highly preferred.

Certificates, Licenses, Registrations

None currently required.

Other Skills and Abilities                                             

Ability to effectively balance a high volume of work and a variety of tasks; ability to prioritize urgent issues effectively.  Strong analytic, verbal and written communication skills.  Detail-oriented with high degree of accuracy and organizational skills.  Able to effectively work as a team player as well as independently Excellent investigative, problem resolution, judgment and decision- making skills required. Excellent presentation and consultative skills, working with internal and external clients at various levels in the organization.

Advancement from the Business QA II position to the Business QA Analyst III position requires the candidate demonstrate the more advanced skills and level proficiencies in the following:

• Assist management by providing additional oversight on multiple medium to high complex business projects.
• Provides thought leadership to team members.
• Participates in influencing process change by leveraging strong written and verbal communication skills.
• Develops a broad understanding of the business, programs and products.
• Displays ingenuity in anticipating and meeting unexpected situations that arise during the implementation phase of the project.
• Strong presentation skills required to review and discuss test methodologies with internal business partners and clients.
• Devises improved means of accomplishing results.

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:

Analytical - Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data; Designs work flows and procedures.

Technical Skills - Assesses own strengths and weaknesses; Pursues training and development opportunities; Strives to continuously build knowledge and skills; Shares expertise with others.

Interpersonal Skills - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.

Oral Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.

Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.

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 15 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 an exempt level position requiring one to work the hours needed to get the job done.  Therefore one must have the flexibility to work beyond traditional hours and be able to work nights, weekends or on holidays as required.  This may be changed from time to time to meet the needs of the business.  Typical core business hours are Monday through Friday from 8:00am to 5:00pm.

Travel

This position may require domestic travel and/or attendance maybe 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/Veterans

OSHA/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.