Network Pricing Management Senior Analyst

CVS Health•Work At Home-Arizona, AZ

11d•$46,988 - $102,000•Onsite

About The Position

This position will be working with a team that is responsible for quality assurance reviews of our client and pharmacy pricing execution of network and mail pricing for CVS Health, a Fortune Company. The Sr. Analyst, you will ensure quality assurance for all client pricing implementations by auditing outputs from our teams across Employer, Health Plan, and Government segments. Your role covers all delivery systems and adjudication platforms related to pharmacy claims adjudication. You will inspect the correct application of business rules, implementation processes, network structures, and pricing documents. Additional job tasks may include operational support for the QA/QC process by reviewing upstream work outputs (e.g. Network Implementation forms), downstream post production (e.g. AS400 network profile coding validations), processing/running any number of tasks and jobs to support production (e.g. macros), and additional coding for state regulations. Being well-organized and deadline-focused, with the ability to make quick, efficient, and effective decisions, is crucial while working in a team and autonomous environment as a self-starter. Competency in MS Excel is essential for ad-hoc data analysis and reporting. Intermediate technical skills are key for utilizing department and company tools. This includes navigating Sarbanes-Oxley and SAS-70 environments and managing internal and external inquiries and responses. Strong interpersonal, relationship, and communication skills are essential to resolve daily challenges and maintain client satisfaction and revenue expectations.

Requirements

3-5 years of operational experience within PBM or Health Care industry.
Ability to meet strict deadlines in a volume heavy environment.
Intermediate to advanced proficiency in MS Office Suite of tools.
Advanced proficiency in Excel and Access desired.
High School diploma, or equivalent experience.

Nice To Haves

Quality assurance audit experience.
Knowledge of CVS Caremark network programs and procedures, including knowledge of retail pharmacy operations and claims adjudication proficiency.
Fundamental project management knowledge and/or demonstrable experience.
Intermediate to advanced interpersonal skills as demonstrated by successful collaboration to achieve common and shared goals across business teams.
Strong time management skills, evidenced by experience being accountable to multiple deliverables on staggered deadlines.
Effective communication skills in both formal and informal written communications and speech at all levels of an organization.
RxClaim system experience.
Bachelor’s degree or equivalent experience.

Responsibilities

Ensure quality assurance for all client pricing implementations by auditing outputs from our teams across Employer, Health Plan, and Government segments.
Inspect the correct application of business rules, implementation processes, network structures, and pricing documents.
Provide operational support for the QA/QC process by reviewing upstream work outputs (e.g. Network Implementation forms).
Provide operational support for the QA/QC process by reviewing downstream post production (e.g. AS400 network profile coding validations).
Process/run tasks and jobs to support production (e.g. macros).
Perform additional coding for state regulations.
Manage internal and external inquiries and responses.