Pharmacy Network Operations Analyst
New
P
PDMIPharmacy Benefit Management
Fully remote opportunityFull-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- 3+ years of pharmacy network experience preferred.
- Required Skills
- SQLData AnalysisReporting
Requirements
- Bachelor’s degree in Health Administration, Healthcare Analytics, Business, Finance, or a related field or equivalent industry experience.
- 3+ years of pharmacy network experience preferred.
- Database development and reporting experience using SQL, TOAD, or similar tools.
- Strong data analysis and data manipulation skills.
- Pharmacy data analysis experience preferred.
Responsibilities
- Acquire and maintain a strong understanding of the pharmacy network structure, rates, MAC pricing, provider demographics, and related operational components.
- Assist in maintaining and updating pharmacy network design, pharmacy demographic data, MAC operations, reimbursement methodologies, and network-related system updates.
- Provide guidance on pricing strategies and implementation considerations for pharmacy reimbursement.
- Conduct research and analysis on claims, pharmacy inquiries, MAC-related issues, and other pricing or reimbursement discrepancies.
- Develop and maintain operational audit tools, provide corrective action follow-up, and support audit activities across the network.
- Create analytical and operational reports related to network performance, MAC activity, Audit claims, pharmacy operations, and client-specific requests.
- Lead or support ad-hoc analysis and reporting to assist internal stakeholders in network decision-making.
- Assist with establishing and updating procedures related to accurate claims adjudication and network maintenance.
- Participate in policy and procedure development for Pharmacy Network operations and support continuous improvement initiatives.
- Build collaborative relationships with internal departments to ensure accurate implementation of network contracts, pricing, and related updates.
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