Analyst, Payor Operations and Solutions

Walgreens•Deerfield, IL

About The Position

Analyzes data to support decision-making on proposals and contracts related to pharmacy programs. Analysis may cover new product pricing, product portfolios, profitability of opportunities with current and new clients, regulatory changes, capital, and profit margins. Helps develop, implement, and monitor strategies and tools to ensure third-party pharmacy programs comply with contractual terms and conditions for designated products or services. The role creates and maintains reports and portals for initiatives, policies, procedures, forms, and contract information. It supports implementation and updates of third-party plans, reviews administrative paperwork, tracks and resolves post-implementation issues, reviews contracts, identifies opportunities and compliance issues, and tracks financial impacts. It also helps develop financial models and performs forecasts and ad hoc analyses, presents findings and recommendations to management, contributes to SOPs, supports client relationships, and assists field personnel and management with member issues.

Requirements

Bachelor's degree, or a high school diploma/GED and at least 3 years of experience in the healthcare industry.
Experience analyzing and reporting data to identify issues, trends, or exceptions and drive improvement and solutions.
Experience using time-management skills to prioritize and organize work, track details, and meet deadlines across multiple projects.
Experience providing customer service to internal and external customers while meeting service quality standards.
Intermediate Microsoft Excel skills.
Intermediate Microsoft PowerPoint skills.
Intermediate Microsoft Word skills.
Understanding of project management and lean methodologies.
Willingness to travel up to 10% for business purposes, within and outside the state.

Nice To Haves

Advanced Microsoft Excel skills.
At least 2 years of experience implementing contracted third-party programs in the healthcare industry.
At least 2 years of experience administering healthcare contracts.
At least 2 years of payor and facility credentialing experience.
At least 2 years of medical reimbursement or fee schedule maintenance experience.
Infusion, Specialty Pharmacy, Retail Clinic, and/or Pharmacy Technician experience.
Experience using Walgreens proprietary systems, such as AS400, SIMS, POS, or IC+.
At least 2 years of experience working in retail pharmacy operations.
Experience providing customer service to internal and external customers, meeting quality standards, and evaluating customer satisfaction.

Responsibilities

Create and maintain reports and portals to post, track, and report on initiatives, policies and procedures, departmental forms, and contracted policies and information.
Assist with implementation of new third-party plans and updates to ongoing plans, including reviewing and approving administrative paperwork before routing information to internal departments.
Track and help resolve post-implementation issues related to contracts and pricing.
Review contracts and provide management with feedback about opportunities, needs related to contracted terms and programs, and contract compliance issues; track financial impact and escalate issues as necessary.
Assist in developing financial models for decision-making related to product development, portfolio analysis, opportunity profitability, capital investments, revenue models, profit margins, and regulatory changes.
Present findings to management and make recommendations that are market competitive and fit Walgreens' strategy.
Perform ad hoc analysis and forecasts for internal management and external customers.
Assist in developing SOPs and provide guidance on Contracts & Pricing processes, procedures, and functionality.
Develop and maintain client relationships, provide services to meet client needs, monitor operational policies and procedures, and report client-service gaps and business non-compliance issues to management.
Assist field personnel and management in resolving member issues.