Analyst, Pharmacy Contract Audit
New
United StatesFull-TimeMiddle
Salary54,236.17 - 64,566.87 USD per year
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Job Details
- Experience
- Minimum two years analytics experience required
- Required Skills
- Data Analysis
Requirements
- Bachelor’s degree or equivalent experience.
- Emphasis in business, finance, economics, or operations preferred.
- Minimum two years of analytics experience.
- Understanding of pharmacy reimbursement programs (AWP, WAC, MAC, etc.).
- Ability to interpret pharmacy contract language.
- Experience with claims data analysis.
- Proficiency in operational and administrative process improvement.
- Ability to interact cooperatively and respectfully with other employees.
- Adherence to compliance program objectives.
Responsibilities
- Analyze reimbursement programs including AWP, WAC, MAC, NADAC, FUL, AAC, and Average Dispensing Fee.
- Field, analyze, and resolve inquiries from pharmacy providers, clients, and internal teams regarding pricing errors.
- Interpret pharmacy contract language and compare against adjudicated claims activity.
- Develop and maintain controls and oversight reporting for contract pricing processes.
- Perform pharmacy network rate testing, chain audits, and impact assessments.
- Resolve pharmacy network pricing setup issues.
- Submit service and recovery requests and engage teams for system updates.
- Improve operational and administrative processes.
- Report contractual compliance activities to leadership.
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