Clinical Services Analyst

Clinical Services Analyst

Job Description

POSITION SUMMARY:
The Analyst, Clinical Services is responsible for ensuring that any changes to Medicare Part D Coverage Determinations, Appeals, Organization Determination and CTM/GRV systems, processes, letters, workflow, and business change requests are appropriately completed. This is a key role to ensure that clients, members and internal colleagues have CMS compliant tools that allow for complete and accurate processing of CD&A cases. The Analyst may work with account teams, implementation managers, business requestors, and/or the UM Development/Medical Affairs teams to ensure that business intent is appropriately interpreted and then configured correctly and tested in the operating system. The Analyst must be able to research and solve complex problems, perform root cause analysis, provide feedback and solutions for meeting our project plans and monthly/quarterly release timelines. The Analyst is accountable for the process/task to be completed appropriately, consistent with the request intent, and on time.

PRIMARY DUTIES AND RESPONSIBILITIES:

The top four or four primary responsibilities of the position in the space provided below:
1. Configuration and self-test of Med D CD&A System
2. Deployment night Pre and post deployment report validation
3. ServiceNow ticket and issue research for CD&A, CTM/GRV operations (7days)
4. Case assignment, some training/BSR/CMS/ System Change meetings

Duties
Configuration and self-testing of Med D CD&A System. Case assignments
Assists in executing the planning, implementation, and execution of Clinical Service operations to ensure compliance with regulatory requirements in support of the organization's objectives.
Analyzes reports and resolves trends, identifies risks, and provides solutions to managers and senior individual contributors.

EDUCATION:
High School or Equivalent required
Bachelor's degree preferred

PRIOR WORK EXPERIENCE:
0 to 3 years

ESSENTIAL QUALIFICATIONS:
Basic problem solving and decision making skills

REQUIRED SKILLS & QUALIFICATIONS:
1. Organize, prioritize, and manage multiple tasks with a high level of detail.
2. Excellent Oral and Written communication skills to be utilized in a consultative fashion.
3. Strong Analytical Skills (Manipulation of data/ Testing and Configuration.)
4. Self-motivated individual with a quick learning curve on complex materials.
5. Ability to work in a high production, time sensitive environment.
6. Computer Knowledge including but not limited to Microsoft office products, Windows based operations.

Preferred:
PBM Knowledge
Analytical Skills
Ability to work in team and independent environments
Time Management Skills
Medicare Knowledge
Able to thrive in time sensitive situations

Notes:
Remote - Shift: MON - FRI 8:00am - 4:30pm CT

VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.