Why work at OpTech?
OpTech is a woman-owned company that values your ideas, encourages your growth, and always has your back. When you work at OpTech, not only do you get health and dental benefits on the first day of employment, but you also have training opportunities, flexible/remote work options, growth opportunities, 401K and competitive pay. Apply today! To view our complete list of openings, please visit our website at www.optechus.com.
Job Summary:
- This position is responsible for assisting Medicare Advantage PPO, HMO and PDP plans meet CMS (Centers for Medicare & Medicaid Services) compliance requirements for PBM oversight, CMS reporting. Is also responsible for reviewing member eligibility and reporting and benefit set up and testing.
Job Responsibilities:
- Develops and improves work flows and business processes within area(s) to improve customer service, decrease operational costs, and improve overall quality.
- Assists Customer Service with questions and clearly communicates responses to inquiries.
- Assist in CMS and other data audits conducted by CMS and internal audit teams
- Identifies and/or analyzes business problems and devise procedures for solutions to the problems.
- Effectively leads projects in order to produce desired results.
- Responsible for corporate communication of project results.
- Recommends and assists with implementing standard policies and procedures.
- Assures that corporate compliance is communicated, implemented, and monitored on an ongoing basis.
- Participates in systems testing, develops procedures/controls, and provides recommendations for the ongoing improvement of the updated process.
- Assists personnel (both internal and external) by answering questions, supplying information, and training.
- Develops and maintains an effective working relationship with customers.
- Participates in group or committee discussions.
- Other related skills may be required to perform this job.
Job Requirements:
- Minimum of 4 years’ experience in a related field is required (prefer health plan or PBM)
- Minimum of 4 years 'analyst experience required with proven experience in operational analysis, data analysis, and problem resolution type activities
- Experience with Microsoft Office applications including Excel, Word and Outlook
- Knowledge of pharmacy claim processing and Medicare guidance related to Part D products
- Experience with PBM systems and tools
- Must have data analysis, and problem resolution skills.
- Strong experience with spreadsheet and/or database skills.
- Experience resolving eligibility and pharmacy claims related issues
- Experience with responding to CMS requests regarding pharmacy claims timely
- Organizational skills and ability to prioritize; must be able to lead multiple activities with varying timeline
- Ability to plan, organize, direct, and control projects. Ability to lead/contribute to process improvement projects
- Excellent written and verbal communication skills
Education/Certifications:
- Bachelor’s degree in a related field is preferred
- Relevant combination of education and experience may be considered in lieu of degree.
OpTech is an equal opportunity employer and is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, status as a parent, disability, age, veteran status, or other characteristics as defined by federal, state or local laws. https://www.optechus.com/eeo_self_identification/
