Adjudication Technician/Plan Programmer
Script Care LTD
Austin, TX

About $58,000 - $75,000 a year

EducationSkills
PURPOSE OF THE ROLE

The Plan Programmer will work closely with the Operations Department and various other departments throughout Script Care. The Plan Programmer requires strong problem-solving skills and will be responsible for reviewing, analyzing and modifying the adjudication system as it pertains to plan design.

KEY TASKS & RESPONSIBILITIES

Set up and maintain group and plan information in the adjudication system. This includes, but is not limited to, adding new groups, changing plan designs and creating new plans, and maintaining network information for each.

Update MAC lists, pricing updates, formulary changes as requested.

Review and report discrepancies in the Medispan daily file loads.

Assist Customer Service, Account Managers and the Specialty and Diabetic Program departments with any questions they have concerning plan setup, rejections, overrides, etc.

Create and run reports for the Account Managers and the Specialty and Diabetic Program Service Representatives for their specific needs.

Test new versions of the adjudication platform as they pertain to benefit design capability and report any issues to the software provider.

Submission of programming requirements for new functionality necessary to code benefit designs.

Interpretation and submission of programming requirements of new industry requirements to the software provider.

Ability to run and analyze full regression and new test claims to ensure benefit designs are coded accurately.

Ability to manage multiple projects and deliverables simultaneously in a high energetic/fast paced environment.

Ability to comprehend and deploy changes under time constraints.

Must be competent to work alone.

QUALIFICATIONS

Education

Bachelor’s Degree or equivalent required

7+ years of benefit plan coding experience in a PBM environment.

PROFESSIONAL SKILLS, EXPERIENCE & COMPETENCIES

Strong analytical and problem-solving skills

Proficiency with the full Microsoft Office suite and eagerness to learn new software programs as needed

Background in Database design in Microsoft SQL is desired but not required

Willing to Travel as needed

Proven ability to manage multiple projects at a time while paying strict attention to detail

Excellent communication/organization skills, both written and verbal

Able to interact with all levels and areas of the Company

Able to support multiple tasks, initiatives, and projects simultaneously

Self-motivated; Positive attitude

Willingness to work outside of normal business hours occasionally

Must be able to remain in a stationary position 50%

Must be able to occasionally move about inside the office to access file cabinets, office machinery, etc.

Constantly operates a computer and other office productivity machinery, such as a copy machine and computer/printer