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Location

Appleton, WI | United States

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Job description

About Us:
We are a dynamic organization committed to reshaping the landscape of pharmacy benefit management. As an innovative alternative to traditional models, we at [Company Name] prioritize affordability and accessibility in the drug supply chain. Our workplace thrives on diversity, encourages creativity, and fosters personal and professional growth. If you're passionate about excellent service and value collaboration, we invite you to explore the opportunity to join our team.

Position Overview:
As a Technical Operations Analyst specializing in Government Programs, you play a crucial role in ensuring the accurate and efficient execution of processes in compliance with CMS regulations. Are you ready to make a meaningful impact?

Key Responsibilities:
- Execute end-to-end technical processes related to Government Programs, including but not limited to:
- Employer Group Waiver Plan (EGWP) enrollment administration
- Retro-eligibility processes
- Financial Information Reporting (FIR)
- Plan Finder Submission
- Coordination of Benefits (COB)
- Reject Management
- Prescription Drug Event (PDE) error management and reconciliation
- Medicaid Encounter Data
- Affordable Care Act (ACA) Claims Submission
- Explanation of Benefits (EOB)
- Retiree Drug Subsidy (RDS)
- Claim Auditing

Your Impact:
- Manage and oversee assigned process schedules, making necessary adjustments to meet deadlines and promptly alerting management of any potential risks.
- Collaborate with internal and external stakeholders, demonstrating independent judgment to resolve issues.
- Ensure accurate documentation of processes, updating as needed.
- Assist in defining and documenting process steps, providing input for technical specifications.
- Identify and propose process improvements, working closely with the Senior Technical Operations Analyst and Business Analyst for implementation.

Qualifications:
- Bachelor/Associate Degree in a business-related field or equivalent education and experience.
- 1-3 years of related work experience, preferably in pharmaceutical claims adjudication systems, retail pharmacy, or a health plan organization.
- Commitment to compliance program objectives.
- Strong interpersonal skills, maintaining cooperative and respectful interactions with colleagues.

What We Offer:
- Flexible working hours (Monday - Friday: 8:00 am-5:00 pm CST, Remote)
- Paid Volunteer Hours
- Educational Assistance Plan and Professional Membership assistance
- Referral Bonus Program - up to $750!
- Industry-leading benefits: Health, Dental, and Vision insurance, Flexible Spending Account, Paid Time Off, Eight paid holidays, 401K, Short-term and Long-term disability, College Savings Plan, Paid Parental Leave, Adoption Assistance Program, and Employee Assistance Program.
Employment Type: Full-Time
Salary: $ 40,000.00 140,000.00 Per Year

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Salary