What are the responsibilities and job description for the Reimbursement Analyst position at ProCare Rx?
PRINCIPLE RESPONSIBILITIES (include but are not limited to):
- Analyze pharmacy claims data utilization to identify financial trends, opportunities, and potential risks, including changes to profit margins.
- Work with Pharmacy Network to identify new contract requirements and methods to validate set up in the system.
- Perform scheduled review and quality assurance of reimbursement in the system.
- Assist the legal team by monitoring, understanding, and acting on state MAC laws.
- Monitor and maintain contractual Generic Effective Rate agreements.
- Assist with implementation of new MAC tables for new clients.
- Assist with MAC review appeals from pharmacies & clients.
- Communicate MAC prices of new drugs with other team members.
REQUIREMENTS
- Bachelor’s degree in Finance, Economics or other business-related field, or 4 years of financial or pricing analysis experience in PBM or Healthcare related field preferred.
- Demonstrate expanded understanding of advanced Excel functionality preferred.
- Aptitude to learn or demonstrated understanding of databases and query languages (e.g., SQL, DBF, Access, SAS, etc.) preferred.
- Ability to effectively communicate, verbally and in writing, potentially technical information to a non-technical audience preferred.
- Ability to work independently and in a fast-paced environment preferred.
- Strong analytical and problem-solving skills preferred.
PHYSICAL DEMANDS
Requires sitting, standing, and occasional light lifting.