Job description
LE0006 MSO of Puerto Rico, LLC
ESSENTIAL DUTIES AND RESPONSIBILITIES
1. Maintain a diligent and responsive administrative foundation for the department.
MATHEMATICAL SKILLS
Ability to calculate figures, and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference and volume. Ability to apply concepts of basic algebra and geometry. Ability to compute rate, ratio and percent and to draw and interpret bar graphs.
REASONING ABILITY
Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
INTERPERSONAL RELATIONS
Internal Contacts
ENVIRONMENTAL AND WORKING CONDITIONS
It's fun to work in a company where people truly BELIEVE in what they're doing!
We're committed to bringing passion and customer focus to the business.
MMM Holdings, Inc.
Job Description
Job Description
BUSINESS UNIT: MMM Holdings, Inc. DEPARTMENT: Pharmacy
POSITION: Pharmacy Operations Support Data Analyst
POSITION: Pharmacy Operations Support Data Analyst
POSITION DESCRIPTION
The Operations Support Data Analyst assures the availability of systems and technology for the Pharmacy Department. The Data Analyst develops queries, reports and databases for the department.
The Operations Support Data Analyst assures the availability of systems and technology for the Pharmacy Department. The Data Analyst develops queries, reports and databases for the department.
ESSENTIAL DUTIES AND RESPONSIBILITIES
1. Maintain a diligent and responsive administrative foundation for the department.
2. Support correction of Prescription Drug Events (PDE) errors to meet established regulatory timeframe.
3. Create, monitor and maintain PDE metric deck.
4. Download and resolve Acumen PDE reports.
5. Work with Relay Health to ensure appropriate Financial Information Reporting (FIR) for member accumulators’ errors are being corrected from an eligibility standpoint.
6. Work with BTS to correct eligibility and accumulator errors identified on the Financial Information Reporting (FIR) on a daily basis.
7. Serve as a representative for Rx Operation Support (RxOps) at the BTS weekly meetings to address any eligibility corrections/block points required.
8. Ensure that users of Pharmacy Information Systems have the availability to use the Pharmacy information systems per the defined requirements and implemented functionalities.
a. Ensure production support issues are identified, tracked, reported on and resolved on a timely manner.
b. Compare set of data files at different points of the exchange process, identify discrepancies and root cause, and work through resolution.
c. Recommend improvements in Rx systems infrastructure.
d. Gather and distribute required reports from FTPs to required stakeholders.
b. Compare set of data files at different points of the exchange process, identify discrepancies and root cause, and work through resolution.
c. Recommend improvements in Rx systems infrastructure.
d. Gather and distribute required reports from FTPs to required stakeholders.
9. Develop queries, reports and databases for the department
a. Run Reports through all internal and external BI tools, as needed.
b. Run Pharmacy Report Cards query every quarter.
c. Build new queries as needed
d. Build Access databases as needed
a. Run Reports through all internal and external BI tools, as needed.
b. Run Pharmacy Report Cards query every quarter.
c. Build new queries as needed
d. Build Access databases as needed
10. Provide support for system enhancements implementations per the defined business needs.
a. Document requirements, specifications, business processes and recommendations, following the validation of the Quality Assurance Analyst.
b. Assemble, organize, document, and store all test results in a centralized location.
c. Perform systems testing as required by the Quality Assurance Analyst.
d. Complete and present IT change control documentation.
a. Document requirements, specifications, business processes and recommendations, following the validation of the Quality Assurance Analyst.
b. Assemble, organize, document, and store all test results in a centralized location.
c. Perform systems testing as required by the Quality Assurance Analyst.
d. Complete and present IT change control documentation.
11. Support new benefit design structure in PCM.
12. Perform PBM CVS-MRD validation and reconciliation for new year benefits for Platino, Non-Platino and EWGPs.
13. Ensure eligibility layout contains new year changes (LICS FL/PR, transition).
14. Perform testing for new year Pharmacy and Medical EOBs (Part B & Over the Counter (OTC) Program).
15. Coordinate new year EOB for Part D and Medical changes.
16. Perform Benefit Testing on a regular basis.
EDUCATION AND EXPERIENCE
- Bachelor’s degree preferably in Information Systems, Mathematics, Industrial or Computer Engineering
- Experience working in a team-oriented, collaborative environment
- Excellent interpersonal skills
- Excellent communication skills to work with customers and top management
- General understanding of project management fundamentals
- Fully Bilingual (English & Spanish)
- Proficiency in MS Office Suite, MS Access and MS Visio
- Proficiency in SQL and Business Intelligence tools are preferred
- Experience in the medical industry and knowledge in the claims’ adjudication process are preferred
GENERAL SKILLS AND REQUIREMENTS
- Understands Internet, Intranet, Extranet and client/server architectures and how legacy and web-based systems interface with each other.
- Preferred with certification and skills in the following areas: ITIL Certification, PM Concepts knowledge or training.
- Self-starter; works independently.
- Communication Skills: bilingual (Spanish/English) verbal and written expression of ideas that ensures understanding by others
- Customer Service Skills: practicing, valuing and supporting service to both internal and external customers
- Time Management Skills: establishing priorities and accomplishing tasks in a timely manner
- Teamwork: ability to work in a team environment to create solutions to problems
- Presentation Skills: ability to present to diverse groups
- Organizational Skills
- Computer Experience: Windows environment, Microsoft Word, Excel, database familiarity and Structured Query Language (SQL) are a plus, and knowledge on pharmacy system applications
LANGUAGE SKILLS
Ability to speak, read and write in English and Spanish. Fully bilingual in English and Spanish is preferred. Ability to read, analyze, and interpret general business documents, protocols, professional journals, technical procedures, and governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from managers, clients, customers, and general public.
Ability to speak, read and write in English and Spanish. Fully bilingual in English and Spanish is preferred. Ability to read, analyze, and interpret general business documents, protocols, professional journals, technical procedures, and governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from managers, clients, customers, and general public.
MATHEMATICAL SKILLS
Ability to calculate figures, and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference and volume. Ability to apply concepts of basic algebra and geometry. Ability to compute rate, ratio and percent and to draw and interpret bar graphs.
REASONING ABILITY
Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
INTERPERSONAL RELATIONS
Internal Contacts
- Staff employees
- Management at all levels of the organization
External Contacts
- Provider and (or) facilities
- Members
- Government and Federal agencies
PHYSICAL AND MENTAL DEMANDS
Requires sitting and standing associated with normal office environment. Regularly talks and hears. This position requires that weight be lifted or force be exerted up to 10 pounds.
ENVIRONMENTAL AND WORKING CONDITIONS
Normal office environment. The noise is typically moderate. Evening or weekend work, as necessary.
This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.
If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!
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