Continue to update MAC Appeals forms, spreadsheets, procedures, etc in the MAC Google Drive site.Follow up with the carriers after submitting appeals in a timely manner.Keep abreast of state level MAC legislation.Record the responses from the carriers, potential savings and cost adjustments in the application.Pull data for Quarterly Business Reviews and Monthly Business Reviews.Performing user acceptance testing on product enhancements.Identifying product enhancements that would be beneficial for clients.Support the Product teams in relation to product enhancements:.Participate in agile missions to improve processes.Follow documented best practices for submitting MAC and Contract exceptions to the carriers.Pursue MAC appeals and Contract exceptions using the Contract Management App and Business Intelligence tools.Tag claims for Audits in the Pharmacy Management tool.Upload claims in the Audit Management App.Contact clients for invoices when needed fax invoices and supporting documentation to the carriers.Design internal and external facing dashboards for trending and benchmarking.Produce reports and other requested deliverables including financial analysis.Participate in product grooming, perform and lead user acceptance testing.Identify, develop and implement new procedures to increase efficiency and productivity of work processes.Use data visualizations appropriately and effectively.
Create and deliver standard MAC reporting on a weekly basis to the client.Run reports and create uploads to vet and submit claims for MAC appeals.Monitor the data to ensure that the carriers adjusted reimbursement.Understand the nature of retail pharmacy.Duties include identifying MAC, pricing and contract exceptions, submitting appeals to the carriers, recording responses from the carriers, preparing standard reporting, interacting with numerous internal and external parties, cross-training with other team members, pulling data and adding MAC appeals information for QBRs and MBRs, product testing and uploading claims and tagging in the Audit Management Application. Under the direction of a Supervisor, the Representative in PFM Business Intelligence is a member of the Business Intelligence team and is responsible for auditing contract and MAC exceptions and supporting client initiatives.
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