Job Location: Miami, FL
Job Detail:
What you’ll do:
In a few words…
Abarca is igniting a revolution in healthcare. We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning…
Providing high quality services to client and beneficiaries is at the core of what we do every day! The PBM Operations & Services team is the very heart of Abarca and meets that standard by running services from MTM, price eligibility, configurations, and beneficiary services to government services and beyond. Our GPS, (Government Programs & Services) teams handle direct contact, data transfers, auditing, and much more for any state or federal agencies as well as government led programs. No one else in this division can talk the talk and walk the walk on Medicare and Medicaid services like they can!
As a Medicaid Data Analyst, you will oversee the accurate management, transfer, and audit of encounter data, related contractual requirements, monitoring encounter submissions and rejections, among other areas. You will support business processes and systems requirements related to monitoring, submitting, and discussing encounter data submission. In this role, you’ll be able to translate regulatory guidance into matching business processes for our operations and technical team. We need your analytical mindset and keen eye to provide analysis as well as determine improvements for our process while we meet service level agreements with state regulators and Centers for Medicaid and Medicare Services.
The fundamentals for the job…
- Perform quality review on encounter data submission files.
- Assess errors, identify root cause, and take action to remediate.
- Engage directly with internal teams to resolve issues.
- Executes user acceptance testing and assess results for accuracy.
- Use analytical tools, such as SQL to conduct data review and analysis.
- Communicate solutions to technical and non-technical audiences.
- Assess regulatory guidance and technical specifications to ensure Encounter Data accuracy.
- Execute effective monitoring programs to ensure all client and state timeliness requirements are met.
- Collaborate with internal teams on client implementations and actively participate with internal workgroups.
- Assess adjudication, logics and claims reprocessing to determine Encounter Data implications.
What we expect of you:
The bold requirements…
- Bachelor’s Degree in a related area (In lieu of a degree, equivalent relevant work experience may be considered.).
- 2+ years of experience with pharmacy benefit management and/or with Medicaid claims management.
- 2+ years of experience working directly with Encounter Data accuracy and resolving Encounter Data errors.
- Experience in defining and communicating requirements.
- Experience in Encounter Data submissions, rejections, processes, and requirements.
- Excellent oral and written communication skills.
That something extra we´d love to see…
- Analytical
- Detailed
- Problem Solver
Physical requirements…
- Must be able to access and navigate each department at the organization’s facilities.
- Sedentary work that primarily involves sitting/standing.
The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.
Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify. Applicant must be a United States’ citizen. Abarca Health LLC does not sponsor employment visas at this time.
All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of gender, race/ethnicity, gender identity, sexual orientation, protected veteran status, disability, or other protected group status.
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