Quality Systems Analyst
EnvisionRxOptions - El Dorado Hills, CA

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POSITION PURPOSE: The Quality Systems Analyst is responsible for supporting the quality systems functions of the company in accordance with the policies and practices of EnvisionRxOptions. This position will be responsible to review the accuracy and timeliness of the adjudication platform, test for compliance and consistency, communicate results to appropriate parties and recommend process improvements that increase efficiency and/or accuracy of adjudication processing while maintaining the exceptional level of professionalism and customer service standards that Envision has attained within the pharmacy benefit management industry.

ESSENTIAL DUTIES AND RESPONSIBILITIES:
  • Forecast implications of software changes across areas of the adjudication platform
  • Serve as project liaison between software development and internal departments
  • Test claims and report on success or failure
  • Analyze and interpret claims processing and adjudication software logic
  • Communicate implications of software updates to internal and external user groups
  • Present findings and field questions from various levels of management
  • Serve as point of contact for troubleshooting adjudication software issues
  • Other duties as assigned

QUALIFICATIONS:
  • Bachelors degree in health administration, business or related field required
  • A knowledgeable individual with appropriate industry experience, preferably in the healthcare, insurance or PBM industry
  • Advanced understanding of claims functions
  • An intelligent and articulate individual who can relate to people at all levels of an organization and possesses excellent communication skills
  • Strong presentation skills
  • Ability to identify business process improvements and report existing deficiencies to management
  • An excellent facilitator who is experienced in resolving conflicts between different parties to a dispute
  • A decisive individual who possesses a strategic focus as well as an operational, implementation and detail oriented perspective
  • A strategic planner with sound technical skills, analytical ability, good judgment and strong operational focus
  • Ability to work with peers in a team effort
  • Demonstrated ability to manage multiple priorities and deadlines
  • A well-organized and self-directed individual who is able to work with minimal amount of supervision
  • Capability to efficiently complete tasks in a fast paced environment
  • Ability to work extended hours, weekends and holidays pursuant with industry demands
  • Knowledge of pharmacy claims adjudication system advantageous
  • Proficient in Microsoft Office and industry related software programs
WORK ENVIRONMENT:

Includes a typical office environment, with minimal exposure to excessive noise or adverse environmental issues.

PHYSICAL REQUIREMENTS:

Ability to sit for prolonged periods of time.

Pre-employment drug screening and background checks are required. The company offers a competitive salary and benefits package. EOE

CareerBuilder - 16 months ago - save job - block
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