• Pharmacy Encounters Analyst

    Job Location US-MI-Detroit
    Job ID
    Business Line
  • 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 Encounters Analyst:

    This position works under the direction of the Department Director and/or Manager. The Pharmacy Encounters Analyst works directly with Clinical Pharmacists, Department Analysts, PBM Clients, and other Internal and External Stakeholders.  The Pharmacy Encounters Analyst is responsible for researching, analyzing, summarizing, creating and submitting Encounter Records.  The Pharmacy Encounters Analyst interprets results, addresses issues and identifies creative solutions to data integrity issues with respect to pharmacy encounter data.   


    • Researches, reviews and interprets encounter data to identify potential issues and address rejected records
    • Monitors, manages and audits encounter submissions to ensure timely and accurate file-submission and processing
    • Develop databases and other tools to provide analyses with respect to tracking encounter submission timeliness and reject rates (by reject-type)
    • Develops, maintains and updates all encounter Policies & Procedures (P&Ps)
    • Coordinates the inter-departmental interactions necessary for addressing encounter related issues and establishing industry best practices
    • Interprets and explains Pharmacy Benefits Manager (PBM) benefits, P&Ps and functions affecting both members, providers, and other internal and external stakeholders
    • Performs continuous monitoring of all encounter processes to identify – and subsequently address – potential quality and/or data integrity-related issues
    • Liaises with stakeholders, including but not limited to, CMS, Commercial Clients, Drug Manufacturers and other PBMs/Managed Care Organizations (as necessary for resolving payment disputes)
    • Collaborates with all operational areas (e.g., Enrollment, Claims, IT, Clinical Operations, Network Development, etc.) in addressing encounter related questions and concerns
    • Maintains Subject Matter Expert (SME) knowledge as it applies to all encounter P&Ps
    • Maintains encounter documentation, including the tracking/trending and monitoring all encounter data submissions – past and present – to ensure overall compliance with Medicare and Medicaid regulations
    • Meets established productivity and timeliness standards with respect to pharmacy encounter data submission and issue-resolution


    What you can bring to MeridianRx:

    • High school diploma is required.
    • Pursuit of Associate’s degree; or Pursuit of Bachelor’s degree; or Pursuit of Fellow designation from the Academy for Healthcare Management (AHM) is preferred.
    • Customer service experience or related health care industry experience is preferred
    • Experience with MHP’s managed care system (MCS) and MeridianRx’s MERLIN system are required
    • Demonstrated adaptability and flexibility to changes and response to new ideas and approaches is required
    • Knowledge of managed care and the Medicaid program is required
    • Knowledge of the health plan programs, benefits, and services for all lines of business for our members
    • Knowledge of National Committee for Quality Assurance (NCQA), URAC or general accreditation standards
    • Knowledge of appeal and grievance guidelines is 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


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