Lead, Configuration and Design Analyst
If you’re interested in a career within a customer-focused, team-oriented environment that rewards innovation, quality, integrity and collaboration, MedImpact Healthcare Systems, Inc. welcomes your application. 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.
This position serves as the lead design analyst for Configuration Services. This individual is responsible for benefit plan implementation, benefit configuration design, training of staff and support. The lead benefit configuration and design analyst is also accountable for client implementations in support of Implementation Services.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
- Leads design and configuration processes for new client implementations including benefit plan design, formulary coding options and pharmacy network configuration solutions by collaborating with external clients, client team members, otherinternal business partners (including Benefits and Pharmacy configuration staff), to ensure that business requirements for benefit change requests are clearly understood, documented, developed, communicated, tested, and delivered flawlessly
- Leads in business process improvement to identify training opportunities and ensures the development and administration of benefit configuration design and coding best practices
- Leads work groups to identify training gaps, define and administer best practice benefit coding develops continuous training for complex POS edits by defining adjudication requirements
- Ensures the development and administration of structured training programs for the configuration services team members to promote quality and flawless execution
- Analyzes complex benefit plan designs to identify claims processing options. Evaluates and develops POS edit enhancements that require a thorough understanding of MedImpact system logic for claims adjudication, system constraints, conflicting benefit logic configurations, benefit coding table designs, plan – group – pharmacy carrier to benefit linking, to ensure proposed design satisfies the intended solution
- Provides consultative exchange with the customer to ensure the customer’s expected outcomes are met and champions clients’ benefit design requirements throughout the organization, including client business model, targeted markets, benefit design objectives, pharmacy network composition, and overall claims adjudication expectations
- Participates in technical design reviews and gathers and documents client requirements and business specifications for client benefits projects. Uses standardized methodology to document requirements and ensures that appropriate rationale exists for non-standard designs and that all efforts are undertaken to prevent inefficient and non-sustainable configuration structures
- Oversees large account implementations, ensuring all elements of the pharmacy and benefits builds are being worked according to pre-defined designs and deadlines
- Reviews and approves configuration design plans for complex and unique benefit requests
- Creates and maintains process standards to document clients’ plan designs, detailing any custom maintenance processes and configuration best practices. Includes documentation of adjudication hierarchies, edits, restrictions, tables, carriers, and other configuration components
- Supports the development of structured training programs to guide the configuration services teams to administer client benefit plan administration. Champions best practices for benefit configuration designs and incorporates standard benefit coding options into custom benefit and network configurations whenever possible
- Maintains an in-depth working knowledge of the MedAccess processing system and ensures up-to-date documentation of adjudication hierarchies, edits, restrictions, tables, carriers, and other configuration components in order to provide technical direction and best practice recommendations for the set-up of client benefit and network designs
- Promotes the adherence to strict procedural and quality standards, including thorough and accurate documentation, testing protocols, and claims analysis and works with Benefits Testing and Validation Analyst to ensure benefit change requests and projects are adequately tested for accuracy and compliance with client business requirements
- Maintains an open dialogue with the client by participating in regularly scheduled implementation calls to understand client business objectives and gather client design requirements
- Provides regular updates to clients, providing appropriate levels of communication between the client and MedImpact staff, and interpreting and providing context for client requests
- Participates in the external test claim review process, and supports the implementation and client teams in obtaining sign off of results prior to move to production, and ensures that configuration changes meet client expectations for accuracy
- Works with the assigned Client Benefits Analysts and Pharmacy Network Analysts to explain the benefit change process to clients during transition from implementation to maintenance of business
- Leads the annual client configuration review with clients, providing an overview of their benefit structures and linkages, highlights changes during the review period, communicates recommendations for improvement, and obtains client signoff on results
- Collaborates and cultivates positive relationships with internal and external customers through delivery of sustainable, measurable, accurate, reliable, and timely results that meet or exceed customer expectations. Promptly responds to service failures, resolves issues, and escalates concerns as appropriate
- Utilizes project planning, prioritizing, and organizational skills to ensure timely deliverables, high levels of quality, and efficient use of resources to achieve claims adjudication accuracy. Ensures appropriate back up coverage for customers during holidays, weekends, and other times
- Promotes continuous improvement by ensuring adherence to quality principles. Seeks out and actively participates in business initiatives that contribute to service excellence.
- Supports new product offerings and strategic marketing efforts
- Leverages Salesforce as the enterprise customer relationship management tool for documenting all client contacts and deliverables requiring follow-up. Oversees assigned cases and ensures adherence to business rules and due dates
- Completes special projects and assignments, and participates as a key member of cross functional workgroups, teams, and committees as assigned
- Works with client teams and shared services staff to develop, maintain, and support standardized and custom benefit and network configurations
- Supports the maintenance of configuration best practices for standard program offerings, including documentation of adjudication hierarchies, edits, restrictions, tables, carriers, and other configuration components
- May participate in best and Final Presentations as a Subject Matter Expert (SME)
- May participate in Implementation Kick off meetings inclusive of travel
Education and/or Experience
For consideration candidates will need a Bachelor's degree (B.A.) from a four-year college or university and/or a minimum of eight (8) years job related experience and/or training in support of client implementations, or equivalent combination of education and job related experience. Candidates should also have project management, proven ability to effectively train staff and Business Systems analysis experience. Previous healthcare or PBM experiencedesired. Pharmacy Technician License with direct pharmacy experience and in-depth drug knowledge and terminology is a plus.
- Intermediate to advanced knowledge of MS Office / Word, Excel PowerPoint, and Outlook
- Experience as an expert user of multiple business software applications and working knowledge of key technical applications such as SQL coding, Oracle forms, Golden 32, Visio, and the ability to run SQL queries and scripts
Certificates, Licenses, Registrations
Pharmacy Technician License or National Certification preferred but not required.