MedImpact Healthcare Systems Inc.

Compensation

Full Description

Exemption Status: United States of America (Non-Exempt) $25.33 - $33.25 - $41.16 “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 Summary Responsible for conducting retail pharmacy network compliance audits and credentialing to ensure compliance with government regulations and decrease fraud. Document and make adjustments to pharmacy claims as determined by audit findings to ensure the integrity and accuracy of the MedImpact’s claims processes by participating pharmacies. Ensures timely credentialing of participating providers by ensuring that records for each network pharmacy are complete and up-to-date. Essential Duties and Responsibilities include the following. Other duties may be assigned. Prepares and completes desktop, document & verification, and on-site audits, including obtaining claim data for selection analysis, reviewing dispensing activities for billing errors, reviewing federal/state/local pharmacy laws, documenting audit results, notifying pharmacies, and preparing travel itineraries, audit plans, & schedules as appropriate; Analyzes pharmacy profile reports for possible claim discrepancies, fraud, and drug abuse; Prepares prescription listings for desktop, document & verification, and on-site audits as appropriate; Performs extensive follow-up inspection of claims data based on extrapolations from initial audit results; Prepares correspondence for pharmacy providers, requesting documentation to validate detected claim discrepancies; Reviews documentation and makes appropriate claim adjustments according to audit findings; Prepares audit outcome documentation for pharmacies; Ensures that results are appropriately documented for clients and that appropriate invoicing of services is completed; Maintains credentialing policies & procedures, work instructions, and documentation processes. Educates stakeholders on credentialing requirements and processes; Facilitates credentialing committee meetings by preparing credentialing information for presentation to the committee, maintaining records of action items, following through on committee decisions, and maintaining thorough documentation of committee activities; Ensures timely credentialing and re-credentialing of participating providers by ensuring that records for each network pharmacy are complete and up-to-date. Ensures that ineligible providers are excluded from network participation as required by state and federal regulations; Adheres to unit guidelines for escalation of issues, including provider non-compliance; Follows unit protocol for notifying management of potential fraud, waste, and abuse. Ensures that critical issues related to pharmacy credentialing and continuing network participation are recognized, documented, and addressed according to department guidelines; Performs report preparation, participation in special projects, problem resolution and other activities that support the provider auditing process. Supervisory Responsibilities 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 accommodation may be made to enable individuals with disabilities to perform the essential functions. Education and/or Experience BS/BA and 2+ years’ experience or equivalent combination of education and experience Computer Skills Intermediate to advanced skill set in MS Office (Word, Excel, PowerPoint, Project, and Outlook) required. Familiarity with relational database systems and SQL software front ends such as Business Objects highly desirable. Intermediate to advanced skill set in MedAccess, MedOptimize and SalesForce preferred. Strong aptitude to learn and adapt to new programs. Certificates, Licenses, Registrations Pharmacy Technician license or national certification highly desired, but not required. Possession of a valid driver’s license and ability to provide a certificate of insurance indicating adequate auto insurance limits (as defined by MedImpact Healthcare Systems, Inc.). Other Skills and Abilities Ability to read and interpret hand-written prescriptions. Knowledge of medications and standard dosages. Strong knowledge of the practice of pharmacy, including statutory laws, regulations, and methods of filling and filing prescriptions. Ability to work independently with minimal direction and strong decision-making ability. Strong organizational and follow-through skills. Strong interpersonal and oral and written communication skills with the ability to maintain tact and diplomacy in difficult situations. Requires technically complex analysis and a high degree of accuracy, carrying with it high consequence of error for MedImpact and its customers. It relies upon business knowledge, including industry concepts and practices, technical skills, and prior experience to plan and accomplish goals. Reasoning Ability Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Mathematical Skills Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry. 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: 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 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 accommodation 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 regularly required to stand; walk; use hands to finger, handle, or feel and reach with hands and arms. The employee must occasionally lift and/or move up to 25 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 accommodation may be made to enable individuals with disabilities to perform the essential functions. This position may regularly be exposed to or encounter moving mechanical parts, high, precarious places, fumes or airborne particles, toxic or caustic chemicals, outdoor weather conditions, risk of electrical shock or vibration. The noise level in the work environment is usually moderate (examples: business office with computers and printers, light traffic). Work Location This position works on-site at the San Diego Headquarters or other company location (or from a remote location with management approval based on business requirements). Must provide adequate support to internal clients; be available for regular interactions and coordination of work with other employees, colleagues, clients, or vendors; as well as be available to facilitate effective decisions through collaboration with stakeholders. Working Hours This is a full-time 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 8:00am to 5:00pm. Travel This position may require domestic travel for up to two (2) weeks at a time. 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. MedImpact was founded more than three decades ago by a pharmacist and independent drug store owner who saw firsthand how families struggled with the high cost of prescriptions, and how it impacted their lives, financial security, and health. So, he started MedImpact to make prescription benefits understandable and accessible. While we have grown to be one of the leading PBMs in America, we remain as committed to these principles today as we did when it all began.