Data Management Anaylst - PRISM

Position Summary

Under the direction of the Prism Project Manager, the Data Management Analyst supports the PRISM Operations and Sales and Client Services departments by managing the day-to-day loading process of electronic remittance to meet contractual obligations for PRISM clients. The Data Management Analyst works closely with the account teams, product development, Pharmacy Benefit Managers, Insurance Carriers, IT production support and GIS to facilitate the file load process. They are responsible for troubleshooting issues for quick resolution. This position requires strong analytical and problem solving skills and the ability to work independently.

Major Job Responsibilities

May include one or more of the following, depending on assigned area:

1. In collaboration with PRISM Product Manager, manage day-to-day loading process of electronic payment files.
• Complete data load process for electronic 835 files within one business day of receipt.
• Monitor and troubleshoot files that did not load properly. Pull in other resources as needed to resolve.
• Work with GIS to automate data load processes where possible.
• Maintain list of file mapping structure for those already automated and those slated for next phase of set up. 
• Document processing business rules that require manual intervention for data load process. Track changes made and keep log of changes on network. 
• Analyze and fix files in BL835, ST835, and Date ERR status. Document steps taken to resolve. 
• Respond to Unknown Carrier 835 upload exceptions for Spectrum uploads.
• Troubleshoot payment batches that go into error in parent/child processing environment timely to ensure files are not held up more than 24 hours.
• Keep manager and Director of PRISM Operations department informed of carrier issues not resolved within one week of receipt of files. 
• Identify and make recommendations for possible efficiency gains to streamline the process.
• Track total number of payment files loaded per week. Report on weekly performance measurements tracking document. 
2. Serve as key resource to PRISM Operations, Sales and Client Services, and Clients.
• Locate and load missing or misdirected files needed for current weeks processing. Contact carriers to facilitate getting the missing files. 
• Communicate carrier notifications regarding data layout, payment cycle, or plan level changes. 
• Review new client carrier list to determine estimated electronic percentage for payment remittance. 
• Track setup requirements by carrier and provide necessary forms to clients for completion and signature. Follow up as needed. 
• Collaborate with Account Representatives to get all new clients to 85% electronic remittance during first 90 days of their start date. 
• Collaborate with Account Team to deliver outgoing payment files to clients via FTP or SFTP per contractual obligations. 
• Collaborate with Account Analysts on changes made to files that negatively impact unapplied cash. Work as a team to resolve. 
3. Collaborate with GIS, Product Development, and Production Support teams to set up new carrier 835 conversions.
• Determine file mapping structure needed, including archiving raw data files and setting up payer controls in iSeries.
• Work with carrier to establish naming conventions to help facilitate load process.
• Establish business rules for processing data layout and work with production support to set up accordingly in prep-process or checker programs.
• Complete system testing for all new payment data loads to ensure data fields are mapped correctly and that all file balances match to check totals. 
4. Serve as Carrier Relationship Analyst to clients.
• Keep current on carrier set up requirements to facilitate conversions from paper remittance to 835 files.
• Maintain carrier notification templates and work with conversion team and client to produce the appropriate letters for sending payment and remittance information. Follow up on changes not made by the carrier timely. 
• Communicate issues and progress made to account teams so clients can be notified accordingly. 
• Coach clients in setting up NCPCP Payment Center Codes or Chain Codes as appropriate.
• Assist with growth of PBM participation in the Central Pay and RxRecon programs for independent pharmacies.
• As directed by manager, participate in industry calls or conferences as representative of on behalf of PRISM clients to address issues with carriers.
5. Perform special projects as assigned
• Serve as representative of PRISM Operations team in joint development meetings or other projects.

QUALIFICATIONS:

• Bachelor’s degree (B.A.) from four-year college or university with a major in business administration, accounting, finance, or related field AND four or more years of related work experience and/or training; OR equivalent combination of training and experience
• Ability to work in fast paced, high capacity work environment
• Ability to use good judgment in recognizing scope of authority
• Ability to proceed independently and carry out assignments to completion with minimal instruction
• Ability to analyze transactions, detect, and avoid errors
• Ability to perform detailed work with numerical data to make mathematical computations rapidly and accurately
• Ability to create documents requiring accuracy and confidential handling
• Ability to maintain detailed, accurate records and files
• Ability to organize tasks and time to ensure timely completion of all projects
• Ability to facilitate communications and problem solve
• Ability to establish good working relationships internally and with clients
• Ability to travel independently
• Ability to work additional hours as needed
• Knowledge of generally accepted accounting principles