Analyst, Government Pricing

Navitus Health Solutions, LLC•,

53d•$63,827 - $76,900•Remote

About The Position

Due to growth, we are adding an Analyst, Government Pricing to our team. The Analyst, Government Pricing is responsible for the development, maintenance, and administration of Medicaid FFS drug pricing methodologies and supporting analytical models. This role ensures accurate, compliant, and competitive reimbursement aligned with federal and state Medicaid requirements, including NADAC, CMS guidance, and HRSA 340B pricing constraints. The Analyst, Government Pricing supports Statements of Work (SOWs), pricing exhibits, and regulatory submissions through detailed financial modeling, data manipulation, and ongoing maintenance of pricing assumptions. This position works cross functionally with compliance, finance, legal, government programs, and client teams to ensure Medicaid pricing integrity, transparency, and audit readiness.

Requirements

Bachelor’s degree in Finance, Economics, Healthcare Administration, Data Analytics, or related field, or equivalent work experience, required.
3+ years of experience in PBM, Medicaid pharmacy programs, managed care, healthcare analytics, or pricing analysis required.
Experience preparing documentation, reporting, and analysis to support internal reviews, regulatory inquiries, audits, and client requests required.
Participate in, adhere to, and support compliance program objectives.
The ability to consistently interact cooperatively and respectfully with other employees.

Nice To Haves

Experience supporting Medicaid fee‑for‑service drug pricing methodologies in alignment with federal and state Medicaid requirements preferred.
Experience working 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 preferred.
Experience conducting pricing impact analyses and maintaining financial models to support Medicaid Statements of Work (SOWs), amendments, and renewals preferred.

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.
Accountable to cross-walk FDB to Medispan or visa versa to ensure compliance with State Medicaid Prescription Drug List and ensure 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 but not limited to Medi Span multisource and product codes (e.g., MONY indicators), NADAC pricing files, and HRSA 340B ceiling price date.
Validate integrity, completeness, and timeliness of reference data used in pricing and modeling and 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.
Other duties as assigned.