Coordinator, Industry Analysis

CVS Health•St. David's, NV

3d•$17 - $31•Onsite

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The Industry Analysis Coordinator is responsible for supporting all aspects of Maximum Allowable Cost (MAC) list maintenance and analysis. This includes creating new MAC lists, managing existing MAC lists, uploading MAC pricing to the adjudication platform, and performing all MAC-related quality control activities. Working closely with the Finance Guarantee team, this role helps ensure client commitments are met through appropriate MAC pricing adjustments. The Industry Analysis Coordinator is responsible for reviewing and responding to pharmacy MAC appeals, collaborating with the Legal team to address MAC-related inquiries and complaints from state agencies, and monitoring pharmacy GER guarantees to identify and recommend pricing adjustments as needed. This position also supports MAC-related reporting activities, including the preparation and distribution of client and pharmacy reports, while helping ensure pricing accuracy, regulatory compliance, and timely resolution of pharmacy inquiries.

Requirements

1+ years of professional work experience in pharmacy claims
1+ years of MS Office experience

Nice To Haves

Experience with RxClaim
Bachelor's Degree
Access Database
SAS

Responsibilities

Reviewing and resolving MAC pricing inquiries from pharmacies (both MAC law states and non-MAC law states) and complying with MAC law requirements.
Validating information from various sources, such as Medi-Span, manufacturers, and wholesalers.
Accurately updating the Pharmacy Inquiry Database with appropriate information and responding to pharmacies within required TAT.
Identifying marketplace condition changes and quickly forwarding potential issues to pharmacists for review in order to minimize impact to pharmacies and plan members.
Maintaining the MACPRICE email box and responding to pharmacy phone calls as required by state laws.