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Job Field: Legal Jobs
Location: San Diego, CA
Salary: $Not stated

JOB SUMMARY:

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<tr><td valign="top" width="450"><b>The Medicare Support Specialist will work internally across functional teams and with external clients interfacing with designated client employees for their Part D support of the Medicare Part D program and related processes. This individual will provide operational support for programs and processes which include True Up and its related activities, FIR transaction rejection resolution, Medicare Part D Plan Finder, Centers for Medicare and Medicaid Services Required Reporting, Retiree Drug Subsidy services as well as other specified activities supporting Government Program and Services. They will impart technical expertise on relational databases, basic programming logic, and file specifications.  This position requires technically complex analysis and a high degree of accuracy, carrying with it significant consequence of error for the organization and MedImpact customers.  The Medicare Support Specialist will assist subject matter experts in defining and documenting process steps policy and procedures, requirements for technical specifications and data requirements to support specified components of Medicare Part D program and related processes. They will perform analytical report analysis and validation, partner with IT or other department members within Government Program and Services, and utilize multiple company databases to obtain, record, and analyze Part D claim data and information. This individual will complete project activities within the prescribed time frame to ensure timely and accurate delivery of Part D services, work proactively under strict deadlines to manage client expectations on issue resolution, and provide customer support to address action items and problems.
The successful candidate will maintain a current understanding of customers, Medicare Part D coverage and benefit plans in order to accurately analyze reports, perform calculations, complete quality control and testing, and ensure appropriate updates and adjustments of data prior to submission to customers. They will ensure accurate Medicare claims data through root cause analysis of errors, make recommendations for systems, procedure enhancements, and education and training as well as make recommendations to department leadership for improvement in workflow processes in order to support Part D reporting requirements. Requirements
For consideration candidates will need a Bachelors degree in Information Technology, Finance, Math or related field from a four year college or university, three 3 to five 5 years of related experience working with Medicare Programs, PBM, Healthcare, or an equivalent combination of education and job related experience. To perform this job successfully an individual will need strong expertise with MS Office tools including Access and Excel and multiple software applications, including legacy and proprietary health care operating systems. Working knowledge of Golden 32 and Oracle/SQL queries is preferred and two 2 to three 3 years of system analysis, systems quality, or data analysis experience is desired. Candid==4000 ates should have a detailed understanding of claims processing concepts, the ability to prioritize urgent issues effectively, outstanding numeric, verbal, written, logic, and analytical skills, an understanding of financial concepts, and previous experience using files and record based system, interpreting file layout and specifications in relational databases. In addition this individual should have proven analytical and decision making skills. Knowledge of healthcare operating systems in the PBM industry and experience with Medicare Programs, enrollment and claims adjudication is preferred.

KEY REQUIREMENTS:

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None Bachelors degree