Eligibility Analyst I

Exemption Status:United States of America (Non-Exempt)$22.24 - $28.90 - $35.57

“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

The Eligibility Analyst I serves as a liaison between Account Management and the Eligibility Department and processes daily client eligibility files. The role performs quality assurance validation to verify file-load accuracy, data integrity, completeness, and adherence to processing requirements; analyzes and remediates record exceptions; and monitors file activity and errors to ensure timely and accurate ingestion. This position collaborates with internal stakeholders to validate requirements, resolve processing issues, and drive issue resolution through strong business acumen and communication skills.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Accountable for Performance Guarantees.

• Assisting in Audits and Sox Compliance.

• Accountable for overseeing and quality review of the Eligibility file loads.

• Performs quality assurance validation of eligibility file loads to verify data integrity, completeness, and adherence to established processing requirements.

• Analyzes and manually remediates eligibility record exceptions to resolve data discrepancies and support accurate downstream processing.

• Coordinates with Account Management to validate file requirements, resolve processing issues, and ensure timely and accurate eligibility file ingestion.

• Performs research and more complicated cleanup activities related to eligibility and synchronization issues with appropriate parties.

• Provides primary day-to-day operational production support for Account Management, becoming the centralized eligibility Subject Matter Expert (SME) for these strategic partners.

• Drives technical system enhancements for error log handling, failed member record re-processing on behalf of clients, and automated file monitoring and alerts in collaboration with IT Data Exchange.

• Writes and maintains detailed reference documentation in support of eligibility.

• Oversees verification of TPAs and Commercial Carriers batch file processing requests are completed, validating file delivery status or manually posting file(s) to secure FTP directories.

Supervisory Responsibilities

No supervisory responsibilities

Education and/or Experience

BS/BA and 1+ years’ experience or equivalent combination of education and experience

Computer Skills

To perform this job successfully, an individual should have intermediate to advanced knowledge of Microsoft Office Suite. Experience using business applications such as Pharmscreens, EPSROI, COB File Manager required following training.

Certificates, Licenses, Registrations

None required

Other Skills and Abilities

• Data analysis experience preferred and healthcare eligibility experience a plus.

Reasoning Ability

• Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.

• Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Mathematical Skills

• Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

• Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.

Language Skills

• Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.

• Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.

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. Ability to maintain clear near visual acuity at approximately 20 inches or less (i.e., “close vision”) to accurately read fine print, view computer screens, and handle small objects. Requires adequate color vision and depth perception to support safety and precision in detail-oriented tasks.

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 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 requires no travel; however, attendance may be required at various local conferences and meetings.

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

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.