Representative, PFM Business Intelligence

Under the direction of a Supervisor, the Representative in PFM Business Intelligence is a member of the Business Intelligence team and is responsible for auditing contract and MAC exceptions and supporting client initiatives. Duties include identifying MAC, pricing and contract exceptions, submitting appeals to the carriers, recording responses from the carriers, preparing standard reporting, interacting with numerous internal and external parties, cross-training with other team members, pulling data and adding MAC appeals information for QBRs and MBRs, product testing and uploading claims and tagging in the Audit Management Application.

Primary Accountabilities:

Analytical

Understand the nature of retail pharmacy

Monitor the data to ensure that the carriers adjusted reimbursement

Run reports and create uploads to vet and submit claims for MAC appeals

Create and deliver standard MAC reporting on a weekly basis to the client

Technical

Use data visualizations appropriately and effectively

Identify, develop and implement new procedures to increase efficiency and productivity of work processes

Participate in product grooming, perform and lead user acceptance testing

Produce reports and other requested deliverables including financial analysis

Design internal and external facing dashboards for trending and benchmarking

Operational

Contact clients for invoices when needed; fax invoices and supporting documentation to the carriers

Run reports and create uploads to vet and submit claims for MAC appeals

Upload claims in the Audit Management App

Tag claims for Audits in the Pharmacy Management tool

Pursue MAC appeals and Contract exceptions using the Contract Management App and Business Intelligence tools

Follow documented best practices for submitting MAC and Contract exceptions to the carriers

Participate in agile missions to improve processes

Support the Product teams in relation to product enhancements:

Identifying product enhancements that would be beneficial for clients

Performing user acceptance testing on product enhancements

Administrative

Pull data for Quarterly Business Reviews and Monthly Business Reviews

Pull data for ad hoc analysis

Record the responses from the carriers, potential savings and cost adjustments in the application

Keep abreast of state level MAC legislation

Follow up with the carriers after submitting appeals in a timely manner

Continue to update MAC Appeals forms, spreadsheets, procedures, etc in the MAC Google Drive site

Share MAC results with the team

Maintain HIPAA (Health Insurance Portability and Accountability Act) compliance in all client communication

Perform special projects and other duties as assigned by management

Required Qualifications:

At least 2 years of relevant experience involving customer service, computer usage, data entry and data analysis AND an Associate’s degree in Business Administration, Accounting, or a related field; OR an equivalent combination of training and experience required to complete the essential functions/job responsibilities of the position

Proficient in Microsoft Office Suite, Microsoft Windows

Competent in 10 Key Manual Entry, Google Office Suite

Individual Competencies:

Adaptable : Responds to change with a willingness to learn new ways to accomplish work.

Teamwork: Builds relationships and works cooperatively with others, inside and outside the organization, to accomplish objectives to build and maintain mutually beneficial partnerships, leverage information and achieve results.

Analytical and Critical Thinking: Ability to tackle a problem by using a logical, systematic, sequential approach.

Communication: Giving and receiving messages and information in written, oral, and visual formats in a clear and concise way for a complete understanding of meaning and intent.

Curious: A desire to inquire and learn, to seek new knowledge and wisdom, and to listen to the contributions of others with a genuine interest to better self, the team, and the organization.

Problem Solving: Gathers and analyzes information to generate and evaluate solutions to problems, issues and challenges while weighing the accuracy and relevance of the facts, data and information.

Collaboration: Works collaboratively with others to achieve group goals and objectives.

• Physical Demands
• The physical demands described here are representative of those that must be met by an associate to successfully perform the major job responsibilities (essential functions) of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the major job responsibilities. This job description is not intended to be an exhaustive list of all duties, responsibilities, or qualifications associated with the job.

Use Hands to Handle Objects - Regularly

Reach with Hands or Arms - Regularly

Talk or Hear and Read Instructions - Regularly

Stand, Kneel, or Stoop and Lift 20 Pounds - Occasionally

View Items at a Close Range - Regularly

• Rarely : Job requires this activity up to 25% of the time
• Occasionally : Job requires this activity between 25% - 50% of the time
• Frequently : Job requires this activity between 50% - 75% of the time
• Constantly : Job requires this activity more than 75% of the time

Individual Competencies

Adaptable: Arrives at a conclusion based on previous experiences and good judgment.

Teamwork: Advanced communication skills used to lead a team.

Problem Solving: Completes routine and repetitive tasks where tasks are straightforward.

Analytical and Critical Thinking: Communicates using persuasion and authority.

Communication: Contributes to strategy for their team.

Collaboration: Creates internal alliances outside the immediate team or department.

Curious: Asseses circumstances using experience and a variety of information gathered.

As an Inmar Associate, you:

Put clients first and consistently display a positive attitude and behaviors that demonstrate an awareness and willingness to listen and respond to clients in order to meet their short-term and long-term needs, requirements and exceed their expectations.

Treat clients and teammates with courtesy, consideration and tact; you also have the ability to perceive the needs of internal and external clients and communicate effectively with the objective of delighting and retaining the client.

Build collaborative relationships and work cooperatively with others, inside and outside the organization, to accomplish objectives, develop and maintain mutually beneficial partnerships, leverage information and achieve results.

Set and attain achievable, yet aggressive, goals with a sense of urgency and accountability.

Understand that results are important and focus on turning mission into action to achieve results following the principles of Flawless Execution while consistently complying with quality, service and productivity standards to meet deadlines and exceed expectations by giving our clients the best possible outcome.

Support a safe work environment by following safety rules and regulations and reporting all safety hazards.

At Inmar, we put people first and that means empowering our associates to thrive at every stage of life and career. Our comprehensive and competitive benefits package is thoughtfully designed to support a wide range of lifestyles and life stages.

Eligible associates have access to:

Medical, Dental, and Vision insurance

Basic and Supplemental Life Insurance options

401(k) retirement plans with company match

Health Spending Accounts (HSA/FSA)

We also offer:

Flexible time off and 11 paid holidays

Family-building benefits, including Maternity, Adoption, and Parental Leave

Tuition Reimbursement and certification support, reflecting our commitment to lifelong learning

Wellness and Mental Health counseling services

Concierge and work/li