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Responsibilities:
- Design and configure client eligibility files based on specific benefit plan designs.
- Build and maintain accumulator files reflecting member deductible and out-of-pocket data.
- Develop scripts to automate file build, testing, and validation processes.
Expertise:
- Apply hands-on PBM claims adjudication knowledge to inform file design and issue resolution.
- Ensure accumulator logic aligns with plan design and claims processing rules.
- Serve as the go-to expert on adjudication logic and NCPDP standards.
Collaboration:
- Partner with Business Analyst and ETL Developer on complex client issues.
- Maintain and improve existing automations as client needs evolve.
- Support change control for file changes and production systems.
AffirmedRx
AffirmedRx brings clarity, integrity, and trust to pharmacy benefit management, aiming to improve healthcare outcomes. A small, collaborative team focused on using clinical approaches and state-of-the-art technology.