MedImpact Healthcare Systems, Inc. · 1 month ago
Prescription Drug Event Analyst I
San Diego, CA
Full-time
Onsite
Entry Level
$22.24/hr - $35.57/hr
1+ years expMedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team! The Prescription Drug Event Analyst I is responsible for the prompt analysis, calculation, reconciliation, and validation of the Medicare Prescription Drug Event (PDE) files for MedImpact customers, ensuring timely and accurate submissions.
Health CarePharmaceutical
No H1B
Responsibilities
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
Defines and documents requirements for technical specifications, data requirements, and procedures to support all components of Medicare claims data analysis, reconciliation, and validation
Utilizes multiple company databases to obtain, record, and analyze complex claim information
Performs calculations, completes quality control and testing, and ensures appropriate updates and adjustments of the data prior to submission to customers. Maintains current understanding of customers' Medicare Part D coverage and benefit plans in order to accurately analyze and prepare Medicare claims data for transmission to customers
Recommends improvement in workflow processes by suggesting procedural enhancements supporting timely and accurate PDE submissions. Ensures continuous improvement of Medicare claims data through root cause analysis of errors, recommendations for systems and procedure enhancements, and education and training as appropriate
Responsible for the establishment and maintenance positive working relationship with both internal and external customers. Participates customer conference calls as the subject matter expert presenting and clarifying Medicare Part D claims data. This role provides sustainable, measurable, accurate, reliable and timely PDE data processes
Active, continual partnership engagement via email, meetings and instant messaging with IT, providing input on data extraction requirements, reporting formats and file layouts
Qualification
Required
BS/BA and 1+ years' experience or equivalent combination of education and experience
Excel
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
Detail oriented with a high degree of accuracy & follow through
Self-starter with the ability to work independently & as part of a team
Ability to influence others, lead small work groups, and coordinate service requests throughout the organization
Strong passion for the customer
Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form
Ability to deal with problems involving several concrete variables in standardized situations
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals
Ability to compute rate, ratio, and percent and to draw and interpret bar graphs
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals
Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public
Composure
Decision Quality
Organizational Agility
Problem Solving
Customer Focus
Drive for Results
Peer Relations
Time Management
Dealing with Ambiguity
Learning on the Fly
Political Savvy
Preferred
Knowledge of healthcare operating systems
Benefits
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
Company
MedImpact Healthcare Systems, Inc.
MedImpact is the nation’s largest independent health solutions and pharmacy benefit company, serving commercial health plans, government programs, self insured/employer groups, and millions of consumers.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
$1.38M2013-09-19Seed· $1.38M
Leadership Team
Frank Bunton
VP, CISO (Chief Information Security Officer)
Larry Biggs
Manager, Information Security
Recent News
Pharmacy Benefit Management Institute®
2025-09-26
2025-09-12
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