Pharmacy Completion Analyst

WHO WE ARE

Founded in 1983, the Medical Review Institute of America (MRIoA) is the market leader for technology-enabled utilization management and clinical medical review solutions. We have an outstanding reputation for excellence and achieve continual improvement.

At MRIoA, we believe our employees are the key to our success. Here, you are more than just a cog in the machine – you are a valued member of our team.

WE OFFER

• A competitive compensation package.
• Benefits include healthcare, vision and dental insurance, a generous 401k match, paid vacation, personal time, and holidays.
• Growth and training opportunities.
• A team atmosphere with fun events and prizes scheduled throughout the year.

POSITION OVERVIEW

Our Pharmacy Completion Analyst is responsible to carry out day-to-day departmental tasks and complete all processes for receiving and reviewing Reviewer decisions, issuing appropriate, timely and accurate review outcome notifications and maintaining online case summary/tracking information.

Roles:

• To finalize the pharmacy case review process and issue review outcome notifications to appropriate parties of the case
• To serve as a company liaison with clients, Reviewers and practitioners/providers/ facilities whose services are subject to review

Major Responsibilities or Assigned Duties:

• Evaluate opinions submitted by Reviewers upon conclusion of their reviews for compliance with company standards for completeness 
• Follow-up with Reviewers whose submitted opinions do not meet all compliance standards
• Issue oral and written review outcome notifications that comply with standards and requirements for timeliness, content, recipients and accuracy including written notification grammar and spelling
• Upload completed decisions into client portals in a timely and appropriate manner
• Research clients’ questions about review processes and/or Reviewer decisions 
• Determine need for additional information or additional review and notify the client and internal departments of these needs
• Provide backup support to staff in other areas as applicable
• Support all Quality Management initiatives
• Actively participate in the Complaint Process and Provider Relations Assessment process
• Support all Compliance Program activities
• Participate in all company meetings and committees as requested
• Maintain a flexible schedule to meet client needs
• Adapt to differences of clients
• Adhere to all policies and procedures
• Take feedback and responsibility for performance
• Complete other duties and responsibilities as directed 
• Monitor and track out of production tasks and hours
• Adapts to the differences of clients

Position Levels

Each level attained compounds responsibilities with those of prior levels. Analyst I-IV & Auditors or exceeds the goals for the respective level (see Career Pathing below):

• Meets or exceeds the goals for the respective level (see Career Pathing attachment)
• Training period to last from date of hire to an estimated 6 months
• Production should increase regularly, with expected career path benchmarks
• Quality should increase regularly, with expected career path benchmarks
• Adherence to all policies and procedures
• Takes feedback and responsibility for performance

California Consumer Privacy Act (CCPA) Information (California Residents Only):

• Sensitive Personal Info: MRIoA may collect sensitive personal info such as real name, nickname or alias, postal address, telephone number, email address, Social Security number, signature, online identifier, Internet Protocol address, driver’s license number, or state identification card number, and passport number.
• Data Access and Correction: Applicants can access their data and request corrections. For questions and/or requests to edit, delete, or correct data, please email the Medical Review Institute at HR@mrioa.com. 

Skills and Experience: 

• Ability to work in a fast-paced and high-functioning environment and meet deadlines while managing multiple high priorities 
• Ability to work independently with minimal supervision
• Personal computer literacy and high competency in use of Microsoft Word and ten key
• Strong organizational skills with strong attention to detail
• Strong oral and written communication skills
• Well-developed training skills
• Strong working knowledge of basic anatomy, physiology and medical terminology
• Strong working knowledge of medical insurance terminology and processes
• Strong working knowledge of prescription drug terminology
• Excellent critical thinking capabilities 
• Exceptional customer service skills
• Thorough understanding and knowledge of Company's clients, products, departments and workflows, and applicable regulatory requirements and accreditation standards 
• Minimum of one year pharmacy experience preferred
• Minimum of one year in a similar operation preferred (health insurance, healthcare and/or managed care arena) preferred

Education:

• High school diploma or equivalent

Work Environment:

Ability to sit at a desk, utilize a computer, telephone, and other basic office equipment is required. This role is designed to be a remote position (work-from-home).

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.



This company is a drug-free workplace. All candidates are required to pass a Background Screen before beginning employment. All newly hired employees will take a Drug Screen, as well as agreeing to all necessary Compliance Regulations on their first day of employment.