VCN Pharmacy Jobs

Virtual Career Network Healthcare mobile logo

Job Information

InnovaCare Pharmacy Operations Support Data Analyst in San Juan, Puerto Rico

LE0006 MSO of Puerto Rico, LLC

It's fun to work in a company where people truly BELIEVE in what they're doing!

We're committed to bringing passion and customer focus to the business.

MMM Holdings, Inc.

Job Description

BUSINESS UNIT: MMM Holdings, Inc.

DEPARTMENT: Pharmacy

POSITION: Pharmacy Operations Support Data Analyst

POSITION DESCRIPTION

The Operations Support Data Analyst assures the availability of systems and technology for the Pharmacy Department. The Data Analyst develops queries, reports and databases for the department.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Mantain a diligent and responsive administrative foundation for the department.

Support correction of Prescription Drug Events (PDE) errors to meet established regulatory timeframe.

Create, monitor and maintain PDE metric deck.

Download and resolve Acumen PDE reports.

Work with Relay Health to ensure appropriate Financial Information Reporting (FIR) for member accumulators errors are corrected from an eligibility standpoint.

Work with BTS to correct eligibility and accumulator errors identified on the Financial Information Reporting (FIR) on a daily basis.

Serve as a representative for Rx Operation Support (RxOps) at the BTS weekly meetings to address any eligibility corrections/block points required.

Ensure that users of Pharmacy Information Systems have the availability to use the Pharmacy information systems per the defined requirements and implemented functionalities.

Ensure production support issues are identified, tracked, reported on and resolved on a timely manner. Compare set of data files at different points of the exchange process, identify discrepancies and root cause, and work through resolution. Recommend improvements in Rx systems infrastructure. Gather and distribute required reports from FTPs to required stakeholders.

Develop queries, reports and databases for the department

Run Reports through all internal and external BI tools, as needed.

Run Pharmacy Report Cards query every quarter.

Build new queries as needed

Build Access databases as needed

Provide support for system enhancements implementations per the defined business needs.

Document requirements, specifications, business processes and recommendations, following the validation of the Quality Assurance Analyst.

Assemble, organize, document, and store all test results in a centralized location.

Perform systems testing as required by the Quality Assurance Analyst.

Complete and present IT change control documentation.

Support new benefit design structure in PCM.

Perform PBM CVS-MRD validation and reconciliation for new year benefits for Platino, Non-Platino and EWGPs.

Ensure eligibility layout contains new new year changes (LICS FL/PR, transition).

Perform testing for new year Pharmacy and Medical EOBs (Part B & OTC ).

Coordinate new year EOB for Part D and Medical changes.

Perform Benefit Testing on a regular basis.

EDUCATION AND EXPERIENCE

Bachelor's Degree in Information Systems preferred or Business Administration or Mathematics from four-year college or university; or two years or more of related experience and/or training; or equivalent combination of education and experience.

GENERAL SKILLS AND REQUIREMENTS

  • Excellent Knowledge of MS Office Suite, MS Visio.

  • Understands Internet, Intranet, Extranet and client/server architectures and how legacy and web-based systems interface with each other.

  • Preferred with certification and skills in the following areas: ITIL Certification, PM Concepts knowledge or training.

  • Self-starter; works independently.

  • Communication Skills: bilingual (Spanish/English) verbal and written expression of ideas that ensures understanding by others

  • Customer Service Skills: practicing, valuing and supporting service to both internal and external customers

  • Time Management Skills: establishing priorities and accomplishing tasks in a timely manner

  • Team Work: ability to work in a team environment to create solutions to problems

  • Presentation Skills: ability to present to diverse groups

  • Organizational Skills

  • Computer Experience: Windows environment, Microsoft Word, Excel, database familiarity and Structured Query Language (SQL) are a plus, and knowledge on pharmacy system applications

LANGUAGE SKILLS

Ability to speak, read and write in English and Spanish. Fully bilingual in English and Spanish is preferred. Ability to read, analyze, and interpret general business documents, protocols, professional journals, technical procedures, and governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from managers, clients, customers, and general public.

MATHEMATICAL SKILLS

Ability to calculate figures, and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference and volume. Ability to apply concepts of basic algebra and geometry. Ability to compute rate, ratio and percent and to draw and interpret bar graphs.

REASONING ABILITY

Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.

INTERPERSONAL RELATIONS

Internal Contacts

  • Staff employees

  • Management at all levels of the organization

External Contacts

  • Provider and (or) facilities

  • Members

  • Government and Federal agencies

PHYSICAL AND MENTAL DEMANDS

Requires sitting and standing associated with normal office environment. Regularly talks and hears. This position requires that weight be lifted or force be exerted up to 10 pounds.

ENVIRONMENTAL AND WORKING CONDITIONS

Normal office environment. The noise is typically moderate. Evening or weekend work, as necessary.

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.

If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!

Innovacare, Inc. is the leading provider of healthcare management in North America. Through two it’s main ways, Medicare Advantage and the provider network, we are committed to healthcare, creating models that are sustainable, cost-effective, and fully integrated with the most advanced technologies. Innovacare, Inc. combines innovation and quality care to create progressive, value-based models, even for the neediest patient populations. Our leadership team, with its vast years of combined experience in managed care and care delivery, is made up of leading experts with proven experience to help healthcare organizations effectively meet and exceed the growing demands of our industry.

InnovaCare Health's foundation was laid by President and CEO Richard Shinto, M.D., in 1998, when he joined North American Medical Management (NAMM) in California. Over the next 10 years, the company continued to grow, acquiring MMM Healthcare in Puerto Rico. In December 2012, the management team successfully sold select NAMM properties and officially formed InnovaCare Health to operate the remaining subsidiaries, including MMM. MMM Holdings, is a conglomerate of companies that work on Puerto Rico's business strategies, both for Medicare Advantage beneficiaries, through Medicare y Mucho Más (MMM), and for the beneficiaries of the government health plan with MMM Multihealth. Through InHealth Management, it manages the in-hospital care of the beneficiaries, while the specialized clinics, MMM Vita Care, serve members with chronic conditions. On the other hand, MSO of Puerto Rico supports medical groups, providers and other entities in the health industry, while Castellana Physicians Services is a medical group dedicated exclusively to providing services for the elderly and disabled population in Puerto Rico.

At the same time, the main company manages Medicare and Much More, a Medicare Advantage population health plan with a presence in Miami-Dade, Broward and Palm Beach counties. With a Mobile Application that allows members to check the status of their pre-authorizations, access their provider directory and schedule their future medical visits, Medicare and Much More integrates technology as a tool to improve the member experience. Also, the plan will ensure the health of members, during and after natural disasters. Through the Florida MMM Line of Care, as a Part D sponsor, you will ensure that the member has adequate access to their covered Part D drugs.

Orlando Family Physicians, a group of clinics that provide comprehensive care services in the state of Florida, is another of the companies managed by Innovacare, Inc. With more than 20 years of service in the Central Florida community and more than 100,000 patients cared, Orlando Family Physicians offers the personalized treatment and care that the patient deserves. With a track record that proves excellent customer service, we are proud that the largest Hispanic medical group in Central Florida has joined us. Our constant growth is the best witness we have to tell that things are being done well, so it is our commitment to continue on this path.

Innovacare, Inc. es el proveedor líder de manejo de servicios de salud en Norteamérica. A través de dos principales vías, Medicare Advantage y la red de proveedores, estamos comprometidos al cuidado de la salud, creando modelos que son sostenibles, costo-efectivos y completamente integrado a las tecnologías más avanzadas. Innovacare, Inc. combina innovación y atención de calidad para crear modelos progresivos y basados en el valor, incluso para las poblaciones de pacientes de mayor necesidad. Nuestro equipo de liderazgo con sus vastos años de experiencia combinada, en atención administrada y prestación de atención, está formado por expertos preeminentes con la experiencia comprobada para ayudar a las organizaciones de atención médica a satisfacer y superar eficazmente las crecientes demandas de nuestra industria.

Las bases de InnovaCare Health fueron establecidas por el presidente y CEO Richard Shinto, M.D., en 1998, cuando se unió a North American Medical Management (NAMM) en California. Durante los próximos 10 años, la compañía continuó creciendo, adquiriendo MMM Healthcare en Puerto Rico. En diciembre de 2012, el equipo de gestión vendió con éxito propiedades selectas de NAMM y formó oficialmente InnovaCare Health para operar las filiales restantes, incluida MMM.

MMM Holdings, es un conglomerado de compañías que trabaja las estrategias de negocio de Puerto Rico, tanto para Medicare Advantage, a través de Medicare y Mucho Más (MMM), como para los beneficiarios del plan de salud del Gobierno con MMM Multihealth. A través de InHealth Management maneja el cuidado intrahospitalario de los beneficiarios, mientras que, las clínicas especializadas, MMM Vita Care, atienden afiliados con condiciones crónicas. Por otro lado, MSO of Puerto Rico apoya grupos médicos, proveedores y otras entidades en la industria de la salud, mientras Castellana Physicians Services es un grupo médico dedicado exclusivamente a proveer servicios para la población de edad avanzada y discapacitada en Puerto Rico.

A su vez, la compañía matriz maneja Medicare and Much More, plan de salud para la población Medicare Advantage con presencia en los condados de Miami-Dade, Broward y Palm Beach. Con una Aplicación Móvil que permite a los afiliados verificar estatus de sus pre-autorizaciones, acceder su directorio de proveedores y agendar sus futuras visitas médicas, Medicare and Much More integra la tecnología como una herramienta para mejorar la experiencia del afiliado. También, el plan velará por la salud de los afiliados durante y después de desastres naturales. Por eso, a través de la línea de cuidado MMM de Florida, como patrocinador de la Parte D, se asegurará de que el afiliado tenga acceso adecuado a sus medicamentos cubiertos de la Parte D.

Orlando Family Physicians, grupo de clínicas que brindan servicios para el cuidado integral en el estado de la Florida, es otra de las compañías manejadas por Innovacare, Inc. Con más de 20 años de servicio en la comunidad de Florida Central y más de 100.000 pacientes atendidos, Orlando Family Physicians ofrece el tratamiento personalizado y la atención que el paciente merece. Con una trayectoria que prueba un excelente servicio al cliente, estamos orgullosos de que el grupo médico hispano más grande en Florida Central se haya unido a nosotros. Nuestro constante crecimiento es el mejor testigo de que las cosas se están haciendo bien por lo que es nuestro compromiso continuar por ese camino.

DirectEmployers