Healthcare Analyst

HYBRID- 1 year. Must come into the office one a week. Detroit, MI Must have knowledge of pharmacy claim processing and Medicare guidance related to Part D products.
The Healthcare Analyst position is responsible for assisting Medicare Advantage PPO, HMO and PDP plans meet CMS compliance requirements for PBM oversight, CMS reporting, review member eligibility and reporting, benefit set up and testing.

RESPONSIBILITIES/TASKS:
1. Develops and improves work flows and business processes within area(s) to improve customer service, decrease operational costs, and improve overall quality.
2. Assists Customer Service with questions and clearly communicates responses to inquiries.
3. Assist in CMS and other data audits conducted by CMS and internal audit teams
4. Identifies and/or analyzes business problems and devise procedures for solutions to the problems.
5. Effectively leads projects in order to produce desired results.
Education:
Bachelor s degree in a related field is preferred. Relevant combination of education and experience may be considered in lieu of degree.
EXPERIENCE:
Four (4) years experience in a related field is required (prefer health plan or PBM).
Experience with Microsoft Office applications including Excel, Word and Outlook.
Must have data analysis, and problem resolution skills. Spreadsheet and/or Database skills.
Experience resolving eligibility and pharmacy claims related issues.
Experience with responding to CMS requests regarding pharmacy claims timely.

SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
1. Knowledge of pharmacy claim processing and Medicare guidance related to Part D products.
2. Organizational skills and ability to prioritize; must be able to lead multiple activities with varying timelines.

G-TECH Services, Inc. is a leading certified recruitment and placement firm that specializes in providing highly skilled staff in technical fields such as engineering, IT, procurement, finance and accounting. We have well-established relationships with some of the most respected companies in the country and know our clients' job requirements and corporate cultures. Once we understand your experience and career aspirations, we aim to connect you with the right opportunity.