Medicare Part D Claims Analyst
This position is responsible for overseeing the accurate adjudication and administration of Part D claims and formulary administration.
- Test the accuracy of the formulary administration policy, including transition, by reviewing daily transition monitoring reports, conducting routine audits on formulary rejections and performing trend analysis.
- Make outreach to members and pharmacies to resolve claims that reject inappropriately.
- Facilitate review of the processes that support retro-active enrollment changes, changes in LICs status, and member notifications
- Report trends in claims rejections and potential areas of non-compliance to Compliance officer.
- Ability to identify member impact by issue.
- Initiate client communications related to trended issues.
- Assist in investigating and correcting operational issues that result in denied claims.
- Develops, implements, and maintains an audit tracking and documentation system.
- Intermediate level of proficiency in MS Excel (writing formulas, filtering and working with large data sets)
- 2+ years of data and complex ad hoc analysis experience
- Deep Medicare part D claims experience
- Pharmacy Tech License preferred