Representative, PFM Business Intelligence

Position Summary:

Under the direction of a Supervisor, the Representative in PFM Business Intelligence is a member of the Business Intelligence team and is responsible for auditing contract and MAC exceptions and supporting client initiatives.  Duties include identifying MAC, pricing and contract exceptions, submitting appeals to the carriers, recording responses from the carriers, preparing standard reporting, interacting with numerous internal and external parties, cross-training with other team members, pulling data and adding MAC appeals information for QBRs and MBRs, product testing and uploading claims and tagging in the Audit Management Application.

Primary Accountabilities:

Analytical

• Understand the nature of retail pharmacy
• Monitor the data to ensure that the carriers adjusted reimbursement
• Run reports and create uploads to vet and submit claims for MAC appeals
• Create and deliver st...