Who we are:
Meridian is a family-owned, family-operated company of passionate leaders, achievers, and innovators dedicated to making a difference in the lives of our members, our providers and in the healthcare industry.
We provide government-based health plans (Medicare, Medicaid, and the Health Insurance Marketplace) in three different states (Michigan, Illinois, and Ohio).
Our employees work hard, play hard, and give back. Meridian employees enjoy: Happy hours, special events, company sports teams, potlucks, Bagel Fridays, weekly Executive Lunches, and volunteer opportunities.
A Day in the Life of a Medicare Data Analyst:
The Medicare Data Analyst is responsible for compiling, analyzing, trending, tracking, and interpreting all operational functions of the Medication Therapy Management (MTM) and Medication Adherence programs. The Medicare Data Analyst coordinates with all internal and external stakeholders in ensuring all regulatory and operational reports are created and submitted. This position will collaborate with the Program Coordinator and Medicare Programs Team Lead to ensure all program functions are completed on time, efficiently, and adhere to all Medicare regulations.
- Analyze all MTM and Medication Adherence reports to develop outlier thresholds, interventions, and other metrics to identify areas of opportunity and develop recommendations for capitalizing on any/all opportunities
- Extract data from MCS, MERLIN and other systems, perform appropriate verification of data, and format, print and distribute reports to internal and external stakeholders, including graphical representations of data/reports as needed
- Maintain current Star rating totals and future state projections
- Complete audits of MTM and Medication Adherence reporting and processes
- Maintain process to ensure MTM program is meeting Compliance standards per CMS guidance for Comprehensive Medication Review and Targeted Medication Review completion rates.
- Communicate the performance of all operational and clinical areas to leadership
- Monitor all state, federal and internal reporting activities for outliers/inconsistencies and determine the root cause(s) of the error
- Create and maintain data universe and participate in yearly onsite data validation process
- Complete all required program reporting needed to maintain a successful MTM and Medication Adherence program
- Compile, analyze and interpret data collected from outreach activities while identifying opportunities for improvement based on data analysis
- Coordination with all departments as needed to perform job functions
- Collaborate with Information Systems (IS) Department in the design and implementation of any/all requested reports
- Research industry standards for MTM and Medication Adherence programs to develop and implement in-house
- Perform other duties as assigned
- Bachelor’s degree or Fellow Designation from the Academy of Healthcare Management (AHM) is required
- Related health care industry experience is preferred
- Experience with MHP’s managed care system (MCS) and MeridianRx’s MERLIN system are preferred
- Demonstrated adaptability and flexibility to changes and response to new ideas and approaches is required
- Knowledge of managed care and the Medicare program is required
- Knowledge of 5 Star ratings
- Knowledge of the Medication Therapy Management and Medication Adherence programs is preferred
- Knowledge of National Committee for Quality Assurance (NCQA), URAC or general accreditation standards
- Have knowledge of commonly-used concepts, practices and procedures within pharmacy operations
- Knowledge of drug products, dosage forms and usage, as well as retail pharmacy operations is preferred.
- Knowledge of medical and pharmaceutical terminology
- Superior organizational and critical thinking skills
- Superior written and verbal communication skills
- Superior analytical and problem solving skills
- Excellent computer skills and interpersonal communication skills; maintains professional demeanor
- Willingness to work in a team environment with a great sense of customer focus
- Detail-oriented with strong organizational skills
- Computer/data entry skills; proficient in data warehouse, database, word processing and spreadsheet applications
- Ability to be patient, courteous and polite to all members, providers and internal/external stakeholder during all engagements
- Ability to learn new skills and acquire knowledge independently and in the group setting
- Ability to think independently to identify solutions and solve problems
- Ability to manage multiple tasks simultaneously
- Ability to work collaboratively and effectively with diverse groups
- Ability to function as part of an interdisciplinary team
- Ability to work with minimal management oversight on multiple projects with competing priorities
- Ability to prioritize work and function under time constraints
- Ability and desire to work in a team atmosphere
Equal Opportunity Employer