Reimbursement Analyst, Pharmacy Network

Navitus Health Solutions, LLC

1d•Remote

About The Position

Due to growth, we are adding a Reimbursement Analyst, Pharmacy Network to our team. The Reimbursement Analyst, Pharmacy Network is responsible for the operation of the Navitus Maximum Allowable Cost (MAC) pricing program and other generic and brand reimbursement systems with pharmacy providers. The objective is to achieve market leading discounts, fair reimbursement to providers, and to ensure maximum competitive pricing is attained. The Reimbursement Analyst, Pharmacy Network supports and evaluates agreements with providers and the MAC program through financial price modeling, analysis, and reporting. This position will communicate and work cross functionally with other teams on generic trends and generic drug discount change effects. Provider and network performance will be analyzed in support of network development, contracting negotiations, and RFP proposals. The Analyst, under the direction and supervision of the Provider Services leadership, is responsible for maintaining a competitive and market leading MAC program and tracking pharmacy performance. The Analyst will also be responsible for managing and responding to pharmacy pricing inquiries in compliance with Navitus response protocol. This position will help monitor and evaluate state MAC requirements to ensure Navitus remains compliant with MAC management and inquiry. The Analyst will assist in working with internal and external partners including pharmacies, clients, vendors, and internal department liaisons to implement and maintain an effective MAC program. Is this you? Find out more below!

Requirements

Bachelor’s degree required. Emphasis in business, finance, economics, or actuarial science strongly preferred. Recent college graduates are encouraged to apply
Participate in, adhere to, and support compliance program objectives
The ability to consistently interact cooperatively and respectfully with other employees

Nice To Haves

Experience in PBM or health care industry preferred.

Responsibilities

Operation and timely administration of the Navitus generic pricing programs including MAC, NADAC, or other pricing structures, which includes determining products to be included on the MAC list and the associated price per unit and updating all pricing within Navitus systems.
Responsible for fielding, analyzing, and resolving inquiries from pharmacy providers, clients, and internal teams.
May evaluate state MAC requirements to ensure Navitus MAC management remains compliant.
May manage quarterly and yearly pharmacy performance and/or reconciliations.
Monitor industry events to determine availability of generic introduction to the marketplace and manage exclusivity timeline for newly introduced generics.
Manage consolidation of generic manufacturers in the market that will affect MAC pricing.
Continuously review and proactively identify areas of opportunities for pricing and discount performance improvement, including analysis and communication of reimbursement activities.
Research customer and contract issues that may affect account planning, strategies, and proposals. Assists with RFP responses as necessary.
Periodic and detailed reporting of activities and opportunities to Provider Services team and cross-functional leadership.
Research external and internal pricing trends and opportunities to contribute to overall pricing strategy.
Perform analyses as requested by internal and external business owners, or in support of identified business objectives, with special focus on pharmacy network profitability and/or client discounts.
Participate in, adhere to and support compliance and diversity, equity, and inclusion program objectives.
Other duties as assigned.