Meridian

  • Pharmacy Enrollment Analyst

    Job Location US-MI-Detroit
    Job ID
    2018-6055
    Category
    Pharmacy
    Business Line
    MRx
  • Overview

    Who we are:

    MeridianRx is a full-service Pharmacy Benefit Manager (PBM) committed to driving down costs and elevating quality. Our clients experience better quality outcomes, thanks to effective clinical support, patient education, and specialty pharmacy programs.


    We work with a diverse range of clients, from members to healthcare providers to plan administrators. MeridianRx services clients across the country and our network continues to grow.


    Our employees work hard, play hard, and give back. MeridianRx employees enjoy: Happy hours, special events, company sports teams, potlucks, Bagel Fridays, and volunteer opportunities.

     

    A Day in the Life of a Pharmacy Enrollment Analyst:

    This position is responsible for enrollment, verification of eligibility, client and group onboarding, encounter rejection resolution, and overall acting as a liaison between the many enrollment systems within Meridian. The role will work closely with the eligibility team and internal MeridianRx departments to ensure communication regarding eligibility issues are escalated and resolved timely.

     

    Responsibilities

    • Oversees the preparation, processing and maintenance of new members and re-enrollment for internal and external clients and all lines of business
    • Work closely with MeridianRx departments, including Call Center, Claims, Formulary, and Implementations to ensure efficiency
    • Monitors enrollment transactions in order to identify any issues with load and processing for internal and external clients
    • Works closely with EDI to test and verify any changes made in processing as well as establish formats and frequency of files for internal and external clients
    • Work closely with MP, MCS, and MERLIN IT teams to understand enrollment pushes and escalate/resolve quickly enrollment issues between the systems
    • Serve as the subject matter expert with enrollment and disenrollment for the organization as it pertains to MERLIN
    • Monitor and resolve enrollment discrepancies between Meridian systems
    • Assist with reconciliation and clean up for PDE/Encounter rejections
    • Report enrollment trends and issues to leadership on a weekly basis
    • Responsible for verifying eligibility for every department and updating MERLIN accordingly
    • Assist with new client and new group onboarding
    • Developing streamline process/standards for outbound reports on enrollment
    • Responsible for verifying and correcting all eligibility issues that occur each month
    • Provide frequent insight and reports on eligibility counts and trends in enrollment
    • Assists with special projects or departmental process improvement efforts
    • Completes all projects as needed for other members of the department when researching eligibility issues
    • Maintains strict confidentiality of member information in accordance with Caidan/HIPAA Privacy Policies
    • Participate and lead weekly Eligibility Meeting
    • Monitor Pharmacy Enrollment Inbox and response/resolve requests in a timely manner

    Qualifications

    What you can bring to MeridianRx:

     

    • High school diploma is required
    • Bachelor’s degree or Fellow designation from the Academy for Healthcare Management (AHM) is preferred
    • One to three years of experience in a Managed Care setting is preferred
    • Three years of experience with MERLIN, MCS, or Market Prominence is required
    • Working knowledge in Microsoft Office applications (Outlook, Word, Excel, etc.)
    • Understanding State and CMS enrollment systems
    • Knowledge of customer relations and team participation
    • Medicare experience preferred

     

    What MeridianRx can offer you:

    • Healthcare benefits that include a variety of plans, which are effective on the first day of employment for our new full-time team members. 
    • Opportunity to work with the industry’s leading technologies and participate in unique projects, demonstrations, conferences, and exclusive learning opportunities.
    • 401k matching that is above the national average. 
    • Full-time MeridianRx employees are eligible for tuition reimbursement towards Bachelor’s or graduate degrees.
    • A bright and engaging company culture; the Meridian family of companies has been recognized as one of Metro Detroit’s Best and Brightest Companies to Work For 5 years in a row. 

     

    Equal Opportunity Employer

     

    Options

    Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.
    Share on your newsfeed

    Connect With Us!

    Not ready to apply? Connect with us for general consideration.