Pricing Manager

Abarca Health•Texas City, TX

11d•Hybrid

About The Position

Abarca is igniting a revolution in healthcare. We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning… As our Pricing Manager you will lead Abarca’s end-to-end Maximum Allowable Cost (MAC) program, including Abarca's networks and leased-network arrangements, to deliver accurate, defensible, and timely generic reimbursement for Commercial, Medicare, and Medicaid. You’ll own MAC operations and strategies to protect the financial interests of Abarca and our clients; manage pricing to client and pharmacy contractual guarantees; implement robust quality assurance processes; and maintain audit-ready governance that balances pharmacy sustainability, plan affordability, and compliance. The fundamentals for the job… Own MAC strategies, and work to transform MAC strategies in MAC pricing lists for retail, mail, specialty, and LTC Implement robust MAC QC process including evaluation of outliers, review of impactful changes, peer review process Analyze client and pharmacy guarantee performance and consult with a cross-functional team to craft strategies that generate savings for Abarca clients Set/tune methodology using NADAC, WAC, AMP, acquisition-cost proxies, floors/minimums, and dispensing-fee logic. Operate MAC under third-party leased-network rules (update cadence, file formats, distribution, communications). Develop performance-guarantee dashboards, and monitor and report out performance to the Pricing Oversight Committee Collaborate cross-functionally to stay highly aware of pharmacy network contracting and generic Maximum Allowable Cost (MAC) pricing strategy to ensure it aligns with the underwriting strategy. Work in Snowflake and within the Darwin platform to identify claims with aberrant pricing and validate accurate application of MAC Own investigations, reporting, and responses related to any audit questions related to MAC pricing Work with the underwriting team to help determine MAC strategies for prospective and new clients Monitor unit cost trend, spread, GER/BER, and outliers; produce monthly MAC scorecards (savings, appeal TAT/overturns, cycle time, top movers). Interpret state MAC statutes and CMS/Medicaid requirements; maintain SOPs, controls, and audit evidence; lead remediation when needed. Define data requirements and QC for Snowflake pipelines (NADAC refresh, vendor feeds, wholesaler invoice ingestion).

Requirements

8+ years in PBM or payer pharmacy pricing/network ops.
3+ years hands-on MAC strategic and operational ownership.
Fluency in generic pricing levers and PBM business model and terminology.
Highly analytical mindset.
Working knowledge of NADAC, WAC, AMP, ASP and state MAC laws; Medicare/Medicaid familiarity.
Data skills: intermediate/advanced SQL (Snowflake preferred) and Tableau/Power BI; strong Excel.
Clear stakeholder communication (pharmacies, clients, regulators) and rigorous documentation.
Flexibility for occasional off-hours support during pricing cycles or audits.
Excellent oral and written communication skills.

Nice To Haves

Proficiency in Python

Responsibilities

Own MAC strategies, and work to transform MAC strategies in MAC pricing lists for retail, mail, specialty, and LTC
Implement robust MAC QC process including evaluation of outliers, review of impactful changes, peer review process
Analyze client and pharmacy guarantee performance and consult with a cross-functional team to craft strategies that generate savings for Abarca clients
Set/tune methodology using NADAC, WAC, AMP, acquisition-cost proxies, floors/minimums, and dispensing-fee logic.
Operate MAC under third-party leased-network rules (update cadence, file formats, distribution, communications).
Develop performance-guarantee dashboards, and monitor and report out performance to the Pricing Oversight Committee
Collaborate cross-functionally to stay highly aware of pharmacy network contracting and generic Maximum Allowable Cost (MAC) pricing strategy to ensure it aligns with the underwriting strategy.
Work in Snowflake and within the Darwin platform to identify claims with aberrant pricing and validate accurate application of MAC
Own investigations, reporting, and responses related to any audit questions related to MAC pricing
Work with the underwriting team to help determine MAC strategies for prospective and new clients
Monitor unit cost trend, spread, GER/BER, and outliers; produce monthly MAC scorecards (savings, appeal TAT/overturns, cycle time, top movers).
Interpret state MAC statutes and CMS/Medicaid requirements; maintain SOPs, controls, and audit evidence; lead remediation when needed.
Define data requirements and QC for Snowflake pipelines (NADAC refresh, vendor feeds, wholesaler invoice ingestion).