Health Care Analyst
Health Care Analyst
Posted on :
03-11-2024
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Job Description
Overview:
TekWissen is a global workforce management provider headquartered in Ann Arbor Michigan that offers strategic talent solutions to our clients worldwide. Our client is a health insurance company. It offers different types of health care coverage plans that include individual and family dental and vision plans for employers etc.
Title: Health Care Analyst
Work Location: Lansing MI 48901
Duration: 13 Months
Job Type: Contract
Work Type: Remote
Dept: Medicare Pharmacy Clini
Engagement Description:
- Responsible for identifying collecting analyzing and maintaining data to evaluate issues that support prospective business decisions.
- Coordinate projects for senior management.
- Bachelors Degree in Business Administration Health Care or a related field is preferred. Two (2) or more years of experience in related field required.
RESPONSIBILITIES/TASKS:
- 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 the client & Emergient 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.
Top 3 Required Skills/Experience The most important musthave 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
Required Skills
- 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 problemsolving skills.
- Ability to effectively interface with employees at all levels.
- Ability to understand and apply statistical inference.
Preferred Skill
- CMS Part D knowledge & CMS regulations
- Knowledge of PBM systems and tools
- Health plan experience
Education
- Bachelors degree preferred
TekWissen Group is an equal opportunity employer supporting workforce diversity.
Employment Type
Full Time
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