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MCO Encounter Systems Analyst [Pharmacy / NCPDP] (Remote)
This job is now closed
Job Description
- Req#: MCOEN001878
Employer Industry: IT Consulting for Health and Human Services
Why consider this job opportunity:
- Competitive pay and a comprehensive range of benefits, including medical, dental, and vision insurance
- Opportunity for career advancement and growth within a stable, privately-owned company
- Work remotely from anywhere within the Eastern or Central Time Zone
- Access to various training courses for continuous learning and skill development
- Supportive corporate culture that emphasizes work-life balance and employee well-being
- Be part of a company dedicated to giving back through its non-profit organization, Fortune Fund
What to Expect (Job Responsibilities):
- Serve as the primary point of contact for Managed Care Organizations (MCOs) regarding encounter file submissions and issue resolution
- Troubleshoot rejected or failed encounters by analyzing root causes and guiding MCOs towards corrective actions
- Review, interpret, and validate NCPDP-standard pharmacy encounter transactions
- Apply strong SQL skills to query, analyze, and validate encounter and pharmacy claims data
- Collaborate with internal teams to investigate issues and provide clear updates on encounter processing activities
What is Required (Qualifications):
- Minimum of 5 years of experience working with Medicaid, Managed Medicaid, or PBM encounter data
- Strong knowledge of NCPDP standard transactions and pharmacy claims processing requirements
- Proficient in SQL for queries, analysis, and troubleshooting
- Experience working with MCOs, PBMs, health plans, or Medicaid programs
- Proven ability to communicate effectively with both technical and non-technical stakeholders
How to Stand Out (Preferred Qualifications):
- Experience in a Systems Analyst or Business Systems Analyst role
- Background in pharmacy benefit management or pharmacy encounters
- Familiarity with EDI environments and encounter rejection codes
- Experience supporting cross-functional teams in a remote environment
#ITConsulting #HealthServices #RemoteWork #CareerGrowth #SQL #PharmacyClaims
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