Analyst, Government Pricing

Overview

An organization in the healthcare sector is seeking an Analyst, Government Pricing to join their team due to growth. This role is responsible for developing, maintaining, and administering Medicaid fee-for-service (FFS) drug pricing methodologies and supporting analytical models. The position ensures accurate, compliant, and competitive reimbursement aligned with federal and state Medicaid requirements, including NADAC, CMS guidance, and HRSA 340B pricing constraints.

The Analyst will support Statements of Work (SOWs), pricing exhibits, and regulatory submissions through detailed financial modeling, data manipulation, and ongoing maintenance of pricing assumptions. This role collaborates cross-functionally with compliance, finance, legal, government programs, and client teams to ensure Medicaid pricing integrity, transparency, and audit readiness.

Responsibilities

• Maintain and administer Medicaid fee-for-service drug pricing methodologies in accordance with federal and state Medicaid requirements.
• Monitor and incorporate National Average Drug Acquisition Cost (NADAC) updates and related CMS guidance into pricing models and operational systems.
• Evaluate and apply HRSA 340B ceiling price considerations and exclusions as applicable to Medicaid reimbursement models.
• Ensure pricing methodologies align with state-specific Medicaid reimbursement rules and contractual requirements.
• Cross-walk First Databank (FDB) to Medispan or vice versa to ensure compliance with State Medicaid Prescription Drug Lists and maintain ongoing reconciliation and updates.
• Support compliance with federal and state audit, reporting, and transparency expectations related to Medicaid drug pricing.
• Maintain and manage industry pricing and reference sources, including Medi Span multisource and product codes (e.g., MONY indicators), NADAC pricing files, and HRSA 340B ceiling price data.
• Validate integrity, completeness, and timeliness of reference data used in pricing and modeling; resolve or escalate discrepancies.
• Assess industry changes that may impact Medicaid pricing assumptions or reimbursement outcomes.
• Maintain and update financial models supporting Statements of Work (SOWs) for Medicaid fee-for-service pricing arrangements.
• Perform detailed pricing impact analyses to support SOW development, amendments, and renewals.
• Manipulate and analyze large data sets specific to SOW requirements, pricing guarantees, and reimbursement terms.
• Partner with internal stakeholders to ensure SOW pricing assumptions are accurate, documented, and supportable.
• Perform other duties as assigned.

Requirements

• Bachelor’s degree in Finance, Economics, Healthcare Administration, Data Analytics, or related field, or equivalent work experience.
• Minimum of 3 years of experience in pharmacy benefit management (PBM), Medicaid pharmacy programs, managed care, healthcare analytics, or pricing analysis.
• Experience preparing documentation, reporting, and analysis to support internal reviews, regulatory inquiries, audits, and client requests.
• Ability to consistently interact cooperatively and respectfully with other employees.

Preferred Qualifications

• Experience supporting Medicaid fee-for-service drug pricing methodologies aligned with federal and state Medicaid requirements.
• Familiarity with industry pricing and reference sources, including Medi Span multisource and product codes (e.g., MONY indicators), NADAC pricing files, and HRSA 340B ceiling price data.
• Experience conducting pricing impact analyses and maintaining financial models to support Medicaid Statements of Work (SOWs), amendments, and renewals.
• Participation in and support of compliance program objectives.

Compensation & Benefits

• Salary range: USD $63,827.16 - $76,900.19 per year.
• STAR Bonus: Up to 5% (at-risk maximum) for salaried non-management employees except pharmacists.
• Health, dental, and vision insurance.
• 20 days paid time off.
• 4 weeks paid parental leave.
• 9 paid holidays.
• 401(k) company match up to 5% with no vesting requirement.
• Adoption Assistance Program.
• Flexible Spending Account.
• Educational Assistance Plan and Professional Membership assistance.
• Referral Bonus Program up to $750.

Work Schedule

• Monday through Friday, 8:00 AM to 5:00 PM.

Location

• Remote within the United States.
• Note: Remote work is not available to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.

Equal Employment Opportunity

The organization is committed to providing equal employment opportunities to all applicants and employees and complies with all applicable nondiscrimination regulations, including those related to protected veterans and individuals with disabilities. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or handicap.