This position is formally known as Network Reimbursement & Payor Compliance Analyst. Under direct supervision of the Director- Pharmacy Performance, assume responsibility for the analysis and compilation of key business indicators that will provide reports to track PBM reimbursement and global profitability based on reimbursement. Tracks and coordinates data to ensure accurate information and assist in the benchmarking. Analyzes internal business reports, and evaluate trend variances and assist with recommendations and implementation of any change. PRIMARY DUTIES AND RESPONSIBILITIES:
Qualifications: EXPERIENCE AND EDUCATIONAL REQUIREMENTS:
- Assists in creation of reports and facilitates data requirements needed to extract and compile data to identify compliance by the PBM.
- Analyze reimbursement and MAC cases to identify opportunities to improve network pharmacy reimbursement. Identify claims that resulted in a high loss
- Develop analysis and reports to support the managed care team in evaluating PBM and contract performance
- Provide reports to track Brand/Generic and 30 day/90 day profitability comparisons and trends
- Quantifies data to assist in developing reports, to determine the financial impact of claims processed by pharmacies
- Provide prospect pharmacy profitability reports as needed by managed care team
- Ensure completeness and accuracy of Manufacturer NDC prefixes in the Hub data for downstream use by other teams
- Maintain specialty drug list for use by other teams in analytics and reports
- Develops reporting to identify specific reimbursement trends related to both Brand and Generic items and prepares written reports detailing the results.
- Quantifies data to assist in developing reports, to determine the financial impact.
- Identifies data quality issues including errors relative to data validity and completeness and ensuring timely resolutions.
- Continually works to develop the specifications for ad hoc report requests and enhancements to existing reports.
- Maintains data related to PRxO Generics and Pricing information to ensure changes are implemented in all reports current and future.
- Performs related duties as assigned.
Requires broad training in fields such as business administration, accountancy, sales, marketing, computer sciences or similar vocations generally obtained through completion of a four year bachelor's degree or equivalent work experience; normally requires a minimum of four (4) years directly related and progressively responsible experience. MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS:
- Knowledge of Pharmacy environment.
- Ability to work independently with general direction.
- Strong analytical skills and attention to detail.
- Ability to convey results of analysis in a easy-to-follow format.
- Excellent organizational skills
- Ability to communicate effectively, both orally and in writing
- Excellent interpersonal skills; ability to work well within a team environment.
- Proficient in Microsoft Office Excel, Access, Word and Power Point
- Experience with relational databases and knowledge of query tools and/or statistical business intelligence software (Micro Strategy) is beneficial.
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