Health Care Analyst - ICONMA, LLC
Remote
About the Job
Our Client, a Health Insurance, is looking for Health Care Analyst for their Remote location
Responsibilities:
Requirements
Why Should You Apply?
As an equal opportunity employer, ICONMA provides an employment environment that supports and encourages the abilities of all persons without regard to race, color, religion, gender, sexual orientation, gender identity or express, ethnicity, national origin, age, disability status, political affiliation, genetics, marital status, protected veteran status, or any other characteristic protected by federal, state, or local laws.
Responsibilities:
- Responsible for identifying, collecting, analyzing, and maintaining data to evaluate issues that support prospective business decisions. Coordinate projects for senior management. Bachelor's Degree in Business Administration, Health Care, or a related field is preferred. Two (2) or more years of experience in related field required.
- Researches, analyzes, identifies, and evaluates data from assigned problems to evaluate existing and potential trends and issues.
- Possesses and maintains a comprehensive understanding and knowledge of client & Emergent business, products, programs (including provider data, networks, etc.), corporate organizational structure (including functional responsibilities), and basic research principles/methodologies.
- Assists in the management and monitoring of multiple projects simultaneously by establishing project plans and objectives to ensure goal attainment within defined parameters.
- Communicates results of analysis to management via reports/presentations and assists management in implementing programs that provide solutions.
- Recommends and implements solutions to identified problems/root cause of issues.
- Provides expertise and guidance to unit and corporate staff as required.
- Represents and participates in group or committee discussions.
- Supports PBM audit and analytics to support Medicare pharmacy services business team.
- Builds and supports business reports to be included in executive dashboard.
- Assist with all functions related to Pharmacy Benefit Manager (PBM) oversight for Medicare Advantage Part D plans.
- Receive and respond to plan related member and provider inquires.
- Troubleshoot problems, inquiries, and provide timely response.
- Works with internal and external partners to ensure compliance with CMS regulations.
- Performs routine tracking, auditing, and reporting of performance in relation to CMS requirements.
- Supports the organization in the event of an internal or external audit.
- Coordinate review of Part D member and provider communications.
- Recommends and assists with development of policies and procedures and desk level guides.
- Assists personnel (both internal and external) by answering questions, supplying information, and maintaining metric and performance dashboards.
- Assist in Monitoring reports to track operational effectiveness and vendor service levels.
- Report reconciliation in multiple software environments.
- Maintain drug lists and HCPCs changes or updates for Part B Utilization Management.
- This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.
Requirements
- Top 3 Required Skills/Experience – The most important must-have skills.
- Health plan, PBM or related experience – at least 2 years
- Strong computer skills and use of existing software packages (Excel, Power Point, Word, Outlook, etc.)
- Knowledge of claims processing and prescription drug names
- Working knowledge of Medicare Part B and Part D
- Ability to plan, organize, direct, and control projects.
- Ability to lead and contribute to process improvement projects.
- Strong communication skills with the ability to understand, interpret, and communicate ideas.
- Strong knowledge and use of existing software packages (PowerPoint, Excel, Word, etc).
- Strong analytical, organizational, planning, and problem-solving skills.
- Ability to effectively interface with employees at all levels.
- Ability to understand and apply statistical inference.
- CMS Part D knowledge & CMS regulations
- Knowledge of PBM systems and tools
- Health plan experience
- Bachelor's degree preferred
Why Should You Apply?
- Health Benefits
- Referral Program
- Excellent growth and advancement opportunities
As an equal opportunity employer, ICONMA provides an employment environment that supports and encourages the abilities of all persons without regard to race, color, religion, gender, sexual orientation, gender identity or express, ethnicity, national origin, age, disability status, political affiliation, genetics, marital status, protected veteran status, or any other characteristic protected by federal, state, or local laws.
Source : ICONMA, LLC
