Analyst, Data Exchange - Eligibility

Location: Remote (For Non-Local) or Hybrid (Local to NYC area)

Position Responsibilities:

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  Attend new client implementation meetings with external partners to discuss eligibility requirements and protocols

  
  

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  Recommend eligibility file formats to external partners and coordinate receipt and processing of eligibility data

  
  

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  Acting as a healthcare data subject matter expert on Eligibility guidelines and Electronic Data Interchange (EDI) protocols

  
  

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  Serving as a point of coordination for member eligibility issue identification and issue resolution with internal teams and external partners

  
  

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  Identify and triage eligibility issues and support the resolution of all errors related to transferring, loading, and management of eligibility data

  
  

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  Proactively monitoring system status and eligibility data to quickly identify potential abnormalities that might impact quality and accuracy

  
  

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  Ensuring that all issues and errors are resolved using designated operating standards and within defined service levels

  
  

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  Assist with the validation of eligibility data integrity through regular audits and reconciliation processes

  
  

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  Ensure accurate and timely entry of group/plan structure determinations for benefits and enrollment

  
  

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  All employees are responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance.

  
  

Required Qualifications:

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  Bachelor's degree

  
  

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  1+ years of previous work experience, preferably in PBM, Healthcare, Data Exchange, and Eligibility

  
  

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  Ability to match key PBM concepts and data fields across various systems and file layouts to ensure consistency and accuracy of data transfers

  
  

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  Ability to analyze complex business problems to discover and resolve root causes

  
  

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  Proficiency in SQL, Excel, JSON and other technical data skills preferred

  
  

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  Strong communication skills with the ability to develop effective work relationships with internal and external stakeholders

  
  

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  Self-motivated and detail-oriented problem solver

  
  

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  Ability to handle multiple competing priorities in a dynamic environment and collaborate in a team

  
  

Visa Sponsorship: Capital Rx does not provide sponsorship to any candidates. This includes, but is not limited to those that require H1-B, TN, OPT, etc. Candidates must have authorization to work in the US at the time of application and throughout employment.

This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.

About Capital Rx

Capital Rx is a full-service pharmacy benefit manager (PBM) and pharmacy benefit administrator (PBA), advancing our nation's electronic healthcare infrastructure to improve drug price visibility and patient outcomes. As a Certified B Corp, Capital Rx is executing its mission through the deployment of JUDI, the company's cloud-native enterprise health platform, and a Single-Ledger Model, which increases visibility and reduces variability in drug prices. JUDI connects every aspect of the pharmacy ecosystem in one efficient, scalable platform, servicing millions of members for Medicare, Medicaid, and commercial plans. Together with its clients, Capital Rx is reimagining the administration of pharmacy benefits and rebuilding trust in healthcare.

Capital Rx values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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