Remote Pricing Operations Analyst

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Posted 21 hours ago United States Salary undisclosed
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Job Description

One of our Pharmacy Benefit Management clients is actively hiring for a Remote Pricing Operations Analyst for the Financial Strategy & Analytics Department. The Pricing Operations Analyst is responsible for creating, analyzing, researching, automating and making suggestions for various pricing schedules, Maximum Allowable Cost (MAC) lists, and executive level reporting by coordinating with pharmacy benefit management (PBM) and mail order operations. This position has no direct reports. Responsibilities include:

- Prepare and maintain generic pricing throughout the MAC lists, across all lines of business, in compliance with pharmacy network contracts to drive bottom line value

- Execute the MAC appeal process by consolidating data, researching industry pricing, and evaluating research and pricing proposals for appropriateness, accuracy, and impact

- Update MAC lists in adjudication system and provide quality assurance of other system changes as necessary

- Complete mail order pricing reports to determine the usefulness of rates and margins

- Report on discount card performance such as changes in product utilization, volume, discount rates, usual and customary rates and market share to Elixir Savings Management

- Provide support as needed on relevant MAC processes and projects to drive bottom line value

- Establish, maintain and support automated systems and processes to increase productivity

- Generalize data structures and processes to facilitate improvements to efficiency through automation

- Verify that claims performance adheres to the effective rate strategy, examine deviations from the target rate and prepare adjustments when necessary, and work directly with Pharmacies on resolving conflicts

- Research industry trends on pricing, brand to generic changes, bio-similar product releases, Food and Drug Administration (FDA) and Drug Enforcement Administration (DEA) decisions

- Monitor drug shortages and potential price increases to generate cost savings and avoid potential financial liability

- Create, maintain, and distribute shortage reports to the appropriate parties

- Monitor new generic drug entrance to market and changes in availability to create and update pricing based on changing market conditions to enhance Client savings

- Perform effective rate reporting for Executive Management to ensure that both corporate goals and contractual obligations are met

- Respond to pricing inquiries from business partners in a timely manner

- Assess and validate claim adjudication setups by both Pharmacy and by Client, as well as investigate sources of discrepancies

Pharmacy benefit management or healthcare insurance experience

Masters Degree

MS access, VBA or SQL Programming knowledge
Bachelor degree in business, mathematical, statistical, financial, or applied science discipline strongly preferred; proven industry experience will be acceptable in lieu of degree

Minimum 2 -3 relevant pricing or finance experience preferred, preferably with a PBM (pharmacy benefit management or healthcare insurance)

Financial and statistical reporting knowledge and experience