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Prescription Drug Event – Sr. Data Analyst / Consultant - Minnetonka, MN or Horsham, PA

UnitedHealth Group

Horsham, PA
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Prescription Drug Event – Sr. Data Analyst / Consultant - Minnetonka, MN or Horsham, PA(Job Number:710675)

If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Financial discipline and accountability count more today than ever. Which is why your performance and innovation will find a reception here like nowhere else as you help people live healthier lives while doing your life's best work.(sm)
The Prescription Drug Event Team is responsible for the prompt analysis, calculation, reconciliation, and validation of the Medicare Prescription Drug Events (PDE) for UnitedHealth Group. They will serve as a subject matter expert for Medicare prescription drug adjudication data and interface with our Pharmacy Benefit Manager and internal staff to ensure timely and accurate PDE submissions and error resolution. This position requires technically complex analysis and a high degree of accuracy, carrying with it significant financial impact for the organization. The Prescription Drug Event – Sr. Financial Consultant will define and document requirements for technical specifications, data requirements and procedures to support all components of Medicare claims data analysis, reconciliation and validation. They will partner with IT, providing input on data extraction requirements, reporting formats and file layouts and will utilize multiple company databases to obtain, record, and analyze complex claim information. As a key player, they will need to maintain a current understanding of Medicare Part D coverage and benefit plans in order to accurately analyze Medicare claims. In addition they will perform calculations, complete quality control and testing and ensure appropriate updates and adjustments to PDEs. This individual will analyze and reconcile PDE entries rejected by CMS, including adjustments related to eligibility, TrOOP, cost sharing, gap discounts and LICS status as well as identify gaps in the benefit and formulary design structure to ensure prompt resolution of all setup issues that impact claims adjudication.

The successful candidate will ensure continuous improvement of Medicare claims data through root cause analysis of errors, recommendations for systems and procedure enhancements, and education and training as appropriate. They will make recommendations to department leadership for improvement in workflow processes as appropriate to support timely and accurate PDE submissions and will establish a positive working relationship with internal and external customers by providing sustainable, measurable, accurate, reliable and timely execution of PDE data responsibilities. It is important that the Prescription Drug Event Event – Sr. Financial Consultant support the corporate strategy by delivering Flawless Fundamentals through solution-oriented problem solving. In addition they will support other departments as the subject matter expert regarding Medicare Part D claims data.

Job Financial Planning & Analysis
Primary Location US-PA-Horsham
Other Location US-MN-Minnetonka
Organization M&R Finance
Schedule Full-time
Number of Openings 1
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UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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