Health Care Analyst

G-TECH Services - Detroit, MI

Full-time - Entry Level

Detroit, MI

Fabricated Metal Product Manufacturing

About the position

The Health Care Analyst position is responsible for identifying, collecting, analyzing, and maintaining data to evaluate issues that support prospective business decisions. This role involves coordinating projects for senior management and requires a comprehensive understanding of healthcare business operations, products, and programs. The analyst will communicate findings through reports and presentations, recommend solutions to identified problems, and support various functions related to Pharmacy Benefit Manager (PBM) oversight for Medicare Advantage Part D plans.

Responsibilities

• Researches, analyzes, identifies, and evaluates data from assigned problems to evaluate existing and potential trends and issues.
• Possesses and maintains a comprehensive understanding and knowledge of Healthcare business, products, programs, corporate organizational structure, and basic research principles/methodologies.
• Assists in the management and monitoring of multiple projects simultaneously by establishing project plans and objectives to ensure goal attainment within defined parameters.
• Communicates results of analysis to management via reports/presentations and assists management in implementing programs that provide solutions.
• Recommends and implements solutions to identified problems/root cause of issues.
• Provides expertise and guidance to unit and corporate staff as required.
• Represents and participates in group or committee discussions.
• Supports PBM audit and analytics to support Medicare pharmacy services business team.
• Builds and supports business reports to be included in executive dashboard.
• Assists with all functions related to Pharmacy Benefit Manager (PBM) oversight for Medicare Advantage Part D plans.
• Receives and responds to plan related member and provider inquiries.
• Troubleshoots problems, inquiries, and provides timely response.
• Works with internal and external partners to ensure compliance with CMS regulations.
• Performs routine tracking, auditing, and reporting of performance in relation to CMS requirements.
• Supports the organization in the event of an internal or external audit.
• Coordinates review of Part D member and provider communications.
• Recommends and assists with development of policies and procedures and desk level guides.
• Assists personnel (both internal and external) by answering questions, supplying information, and maintaining metric and performance dashboards.
• Assists in monitoring reports to track operational effectiveness and vendor service levels.
• Reports reconciliation in multiple software environments.
• Maintains drug lists and HCPCs changes or updates for Part B Utilization Management.

Requirements

• Bachelor's Degree in Business Administration, Health Care, or a related field is preferred.
• Two (2) or more years of experience in related field required.
• Health plan, PBM or related experience - at least 2 years.
• Strong computer skills and use of existing software packages (Excel, Power Point, Word, Outlook, etc.).
• Working knowledge of Medicare Part B and Part D.
• Ability to plan, organize, direct, and control projects.
• Ability to lead and contribute to process improvement projects.
• Strong communication skills with the ability to understand, interpret, and communicate ideas.
• Strong analytical, organizational, planning, and problem-solving skills.
• Ability to effectively interface with employees at all levels.
• Ability to understand and apply statistical inference.

Nice-to-haves

• CMS Part D knowledge & CMS regulations
• Knowledge of PBM systems and tools
• Health plan experience