Reimbursement Analyst, Pharmacy Network

Overview

This role supports and evaluates pharmacy provider agreements and the Maximum Allowable Cost (MAC) program through financial price modeling, analysis, and reporting. The Analyst collaborates cross-functionally on generic trends and how generic drug discount changes impact pricing. Responsibilities also include analyzing provider and network performance to support network development, contracting negotiations, and RFP proposals.

Responsibilities

• Operate and administer generic pricing programs, including MAC, NADAC, and other pricing structures
  • Determine products included on the MAC list
  • Set associated price per unit
  • Update pricing in Navitus systems
• Field, analyze, and resolve inquiries from pharmacy providers, clients, and internal teams
• Evaluate state MAC requirements to maintain compliance
• Monitor industry events to identify generic introductions to the marketplace and manage exclusivity timelines for newly introduced generics
• Manage effects of generic manufacturer consolidation on MAC pricing
• Continuously review and proactively identify opportunities to improve pricing and discount performance
  • Analyze and communicate reimbursement activity
• Research customer and contract issues that may affect account planning, strategies, and proposals
  • Assist with RFP responses as needed
• Provide periodic, detailed reporting of activities and opportunities to Provider Services and cross-functional leadership
• Research external and internal pricing trends to support overall pricing strategy
• Perform analyses requested by internal and external business owners, supporting business objectives (with a focus on pharmacy network profitability and/or client discounts)
• Other duties as assigned

Requirements

• Bachelor’s degree required
  • Emphasis in business, finance, economics, or actuarial science strongly preferred
  • Recent college graduates are encouraged to apply
• Participate in, adhere to, and support compliance program objectives
• Ability to consistently interact cooperatively and respectfully with other employees

Compensation & Benefits

• Pay range: USD $54,236.00 - USD $64,567.00 /Yr.
• STAR Bonus % (At Risk Maximum): 7.50
  • Salaried, Non-Management except pharmacists
• Top-of-industry benefits for Health, Dental, and Vision insurance
• 20 days paid time off
• 4 weeks paid parental leave
• 9 paid holidays
• 401K company match of up to 5% (No vesting requirement)
• Adoption Assistance Program
• Flexible Spending Account
• Educational Assistance Plan and Professional Membership assistance
• Referral Bonus Program – up to $750!

Location

• Remote (US)
• Remote work is only available to residents of: Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Jersey, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Tennessee, Texas, Utah, Vermont, Virginia, Washington, Washington DC, Wisconsin

Work Schedule

• M-F; 8am-5pm CT

Equal Employment Opportunity

The employer provides equal employment opportunity to all applicants and employees and complies with applicable nondiscrimination regulations, including those related to protected veterans and individuals with disabilities. Qualified applicants are considered without regard to race, color, religion, sex, national origin, or handicap.