The Burchfield Group, Inc. (Burchfield) is a privately-held consulting firm, founded in 1998 and located in St. Paul, Minnesota, which specializes in the pharmacy benefit management (PBM) arena. The company's goal is to provide industry-leading insight that guides plan sponsors through the complexities of the pharmacy benefit market. From prescription benefit management proposal analysis and audits to on-going utilization review, Burchfield’s comprehensive approach combines advice, advocacy and action, along with meticulous attention to detail and follow through.
Burchfield's experienced staff of over 40 employees represent more than 450 years of pharmacy-specific expertise including PBM operations, clinical, finance/underwriting, and implementation, plus experience in community pharmacy, pharmaceutical manufacturing, and sales and Internet retailing. Knowledge of the industry from the inside combined with keen financial acumen gives Burchfield a strong competitive advantage.
Burchfield recognizes that talent is the key to its success. The company is embarking on a tremendous growth initiative and is seeking the very best and brightest Talent to join their team. The company is currently identifying and evaluating candidates for Medicare Part C Utilization Specialist.
More information on The Burchfield Group can be found at: www.burchfieldgroup.com
Position Overview:
The Burchfield Group has an immediate opening for a Part C Utilization Specialist to join its growing Medicare department. The Part C Utilitzation Analyst will be working directly with the Data Validation System Project Manager in reviewing client’s Policy & Procedure (P&P) documents, analyzing and reporting of Medicare Part C & D client data.
Responsibilities/Accountabilities:
Leadership
· Reviews and evaluates P&P documents and performs gap analysis;
· Leads and trains specialists to perform the client's work process evaluation; and,
· Creates and maintains technical project documents internally and for external delivery, to the Data Validation Systems PM.
Client Satisfaction and Perception of Value
· Responsible for maintaining active client communication to manage expectations and deliverables, ensure satisfaction, and lead necessary change efforts effectively;
· Ability to understand client's work processes to contribute to data requests/review incoming source documentation from clients; and,
· Ability to provide appropriate technical, audit, compliance and operational expertise to each client engagement.
Business Development
· Helps to secure client relationships and sell new services to assist clients in achievement of their data validation goals;
· Helps to ensure retention of clients and associated revenue related to data validation services;
· Provides data validation client information to be used in monthly, quarterly, and annual client revenue forecasts for client Book of Business; and,
· Ensures timely reviews of proposals, contracts, and marketing materials related to data validation services.
Requirements:
Skills
· Proven ability with process improvement initiatives and contributing to business solution service orientation;
· Proven analytical, technical and auditing skills;
· Proven ability to comprehend process and systems logic;
· Excellent written, verbal and presentation skills; and,
· Uses technology to support the business.
Knowledge
· Understands ICD9 codes and coding systems;
· Complete knowledge and understanding of billing codes (e.g., HCPC and DRG);
· Understands HEDIS reporting process;
· Processes regarding eligibility and grievances collection and applications a plus; and,
· Demonstrates knowledge and hands-on experience in working on a formal project team.
Personal Attributes
· Demonstrates innovation and creativity in work
· Possesses keen ambition and personal commitment to excellence;
· Exhibits strong work ethic and takes ownership of goals/objectives;
· Takes initiative and is self directed;
· Demonstrates effectiveness in working as a team; and,
· Displays professionalism and commitment to quality.
Travel Expectations: As needed
Posting Qualifications:
· Bachelor's degree with significant experience in medical practice, RN preferred;
· Knowledge of healthcare billing requirements, Medicare rules, and basic insurance understanding;
· Strong communication and analysis skills, team player, organized, precise, and a self-starter; and,
· Working knowledge of Microsoft Excel, Word, Power Point, Access and other computer programs.
Please apply at: http://burchfieldgroup.prevueaps.com