GPS Specialist I

Exemption Status:

“Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors.  A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate.”

This position is not eligible for Sponsorship.

MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team!

Why join MedImpact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare.

At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution!

Job Description

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• This position supports PharmScreens adjudication processes

  Communicates CMS guidance changes and updates to the clients.  Keeps up-to-date with CMS guidance changes and how MedImpact implements changes in-line with state and federal guidelines. 

• Provides internal and external support to ensure MedImpact and its clients adhere to processes and  to ensure compliance with related regulations. Works across the organization to expeditiously resolve issues, escalate service recovery efforts and provide timely feedback.
• Ensures client comprehension of MedImpact’s processes and CMS guidance.
• Explains new programs and enhancements to existing programs to clients.  Communicates major file and report changes to clients by having a detailed understanding of any changes.
• Adheres to strict procedural and quality CMS standards and corporate guidelines; aids in the creation of  documentation; analyzes claims while applying a thorough understanding of assigned clients’ technical and service requirements.
• Works with internal departments (Information Technology, Operations Client Business Analyst and others) to resolve client specific claims issues.
• Maintains familiarity with the various plan designs, benefit setups, pharmacy networks, claims adjudication and formulary for assigned clients.  Keeps the “Client Profile” updated with requisite information. 
• Provides client-facing support for project Implementation and/or internal implementation support including Sales/Account Management support for Business Development.
• Provides team representation and management of client interfaces regarding specific program aspects. 
• Completes project activities within the prescribed time frame to ensure timely and accurate delivery of services.  Manages client expectations on issue resolution and provides customer support to address any action items/issues or problems by working proactively under strict deadlines.

Supervisory Responsibilities                                 

This job has no supervisory responsibilities.

Client Responsibilities

This is an internal and external client facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written).  One must be able to; Respond promptly to client needs; Solicit client feedback to improve service; Respond to requests for service and assistance from clients; Meet commitments to clients; Manage difficult or emotional client situations.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience                                              

Bachelor's degree (or equivalent combination of education and experience) along with 2+ years’ experience in a related industry. Good familiarity with regulatory agencies and CMS guidance a plus. Experience in PBM, pharmaceutical, or managed healthcare industry a plus.

Computer Skills

To perform this job successfully, an individual should have knowledge intermediate knowledge of MS Office Suite (Word, Excel, PowerPoint), Outlook or other email system and databases.

Certificates, Licenses, Registrations

Pharmacy Technician, not required, but preferred

Other Skills and Abilities                                        

• Good understanding of Center for Medicare and Medicaid Services (CMS), State and Federal regulations and guidance with the ability to assimilate and keep up to date with changes.
• Possesses a cross-functional understanding of GPS processes within different departments preferred. 
• Intermediate to advanced understanding of claim processing concepts.
• Strong Interpersonal skills with the ability to work effectively with differing personalities and levels of employees.
• Well defined decision-making skills, including proven problem analysis and discerning communications under pressure.
• Demonstrated business acumen combined with a strong understanding of the business processes associated with PBM service delivery.   
• Able to work under tight deadlines in a results-driven department.    

Reasoning Ability                                                    

Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Mathematical Skills                                                 

Ability to calculate figures and amounts such as discounts, proportions, percentages.  Ability to apply concepts of basic algebra. 

Language Skills

Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.  Ability to write reports, business correspondence, and procedure manuals.  Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.    tools (including Excel, Word and Outlook).

Competencies                                   

To perform the job successfully, an individual should demonstrate the following competencies:

• Interpersonal Effectiveness - Demonstrates good people skills by showing a commitment to teamwork, resolving conflicts effectively and with respect for others’ viewpoints, respecting differences and building strong relationships and networks.

• Job-specific Expertise - Demonstrates solid command of relevant knowledge, skills, techniques and technologies, keeps current with recent developments and best practices in the field, and establishes self as the go-to person for up-to-date knowledge in his or her area.

• Problem Solving - Analyzes problems logically to identify root causes, seeks input from a wide range of sources, asks insightful questions and formulates effective solutions.

• Responsiveness - Responds promptly, appropriately and effectively to requests, feedback and new developments, making sure that all relevant concerns and requirements are understood and addressed.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear. The employee is occasionally required to stand; walk and reach with hands and arms. The employee must occasionally lift and/or move up to 10 pounds.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.

Work Location

This position works on-site at the San Diego Headquarters (or other company location) for purposes of providing adequate support to internal clients; being available for face-to-face interactions and coordination of work with other employees, colleagues, clients, or vendors; as well as for facilitation of quick and effective decisions through collaboration with stakeholders.  Periodic scheduled remote work may be permitted as allowed under the department’s policy and with management approval. 

Working Hours

This is an exempt level position requiring the incumbent to work the hours required to fully accomplish job responsibilities and reasonable meet deadlines for work deliverables. The individual must have the flexibility to work beyond traditional hours and be able to work nights, weekends or on holidays as required.  Work hours may be changed from time to time to meet the needs of the business.  Typical core business hours are Monday through Friday from 8:00am to 5:00pm.

The Perks:

• Medical / Dental / Vision / Wellness Programs
• Paid Time Off / Company Paid Holidays
• Incentive Compensation
• 401K with Company match
• Life and Disability Insurance
• Tuition Reimbursement
• Employee Referral Bonus

To explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to www.medimpact.com/careers

MedImpact, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego,
California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high-value solutions to payers, providers and consumers of healthcare in the U.S. and foreign markets.

Equal Opportunity Employer, Male/Female/Disabilities/Veterans

OSHA/ADA:

To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Disclaimer:

The above
statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.