What you’ll do
In a few words…
Get ready to appease your analytically inclined restless mind. As a PDE Analyst, you will be asked to conduct investigations and resolve complex issues putting your strong analytical and communication skills to the test. Your inquisitive mind will be ultra happy searching for answers and solutions to complex tasks. In your role, you will be accountable for researching and successfully resolving PDE errors and rejections. You will benefit from your sharp mind that quickly grasp new cases and acquires platform knowledge through independent study, as well as interaction with other team members. The ability to discuss technical logic, awareness of when to be detailed, and assurance evoked through understanding of our solutions and technology is essential and probably comes naturally to you.
The fundamentals for the job…
- You should have a solid understanding of Medicare PDE processing and be able to:
- Locate, read, understand, and apply CMS guidance to your processes as necessary.
- Be proficient in calculating PDEs
- Analyze and resolve PDE errors. This includes identifying situations where reprocessing and adjustments are required. (Use your very own Spidersense.)
- Review PDEs to ensure accuracy and compliance with regulations (Guidelines, guidelines, and more guidelines… Good thing you always colored inside the lines!)
- Resolve Acumen incidents related to PDEs (Problem-solving will be one of your main tasks.)
- Understand and execute quality assurance checks on PDE file submissions.
- Understand and explain general drug terminology like drug hierarchy, drug indicators like brand/generic, multi-source code, repacks, DESI codes, etc. and how those may impact adjudication or PDE processing.
- Stay up to date on CMS guidance related to Medicare Part D products. Understand and reference said guidance when analyzing and resolving issues.
- Identify and proactively suggest process improvements.
- Provide client support and/or compliance/audit activities and collaborate in special projects and activities as assigned (How special do you feel?)
What you’re made of
The bold requirements…
- 2+ years working with Medicare Part D claims, PDE, benefit configuration or similar strongly preferred.
- You notice the little things and that helps you quickly spot patterns and discrepancies.
- Ability to thrive in a high-growth, fast-paced, complex, shifting, and uncertain business environment (Like an extremophile, you can survive in extreme conditions.)
- Highly organized and self-motivated, you can juggle multiple important investigations simultaneously.
- Computer proficiency: You know the nuances of Microsoft Office products like you were Bill Gates himself.
- Ability to think analytically and consider all client configurations, dive into the details, and know when to operate at each level
- You can communicate effectively (read, write, speak, assume, decompress, have therapy, research the recesses of Google’s search engine, subtract, and text your mom) in English. Spanish is a plus.
That something extra we´d love to see…
- Integrity: When nobody is looking, you behave exactly the same as when everyone is there. That’s because you’re loyal and honest down to your very DNA. It may seem somewhat boring, but it’s as rare as element 115 and just as precious.
- Analytical: You wear a spyglass on your sleeve, examining past, present, and possible futures more intensely than Dr. Strange. Your frequent overanalyzing is one of your trademarks and it helps you foresee things to your advantage.
- Responsible/Accountable: You’re one of the most, if not THE most reliable person in the room. You own up to what you say and do, and correct things when you make mistakes. Honesty and loyalty are your most prized assets.
- Problem solver: You’re attracted to problems like a moth to a flame. But unlike, the moth, problems make you stronger. They drive your motivation and you don’t stop until you find the solution. Fixer-upper? Bring it!
- Detailed: You notice everything, every little thing; and you rarely forget any of it. Your attention to detail borders on photographic and your spirit animal is a hawk. If anything changes, you notice.
The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is absolutely 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. 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.