Reimbursement Analyst

ProCare Rx • Gainesville, GA

8h

About The Position

This role involves analyzing pharmacy claims data to identify financial trends, opportunities, and risks, including changes to profit margins. The analyst will collaborate with the Pharmacy Network on contract requirements and system setup validation. Responsibilities include performing scheduled reviews and quality assurance of reimbursement, monitoring state MAC laws for the legal team, maintaining contractual Generic Effective Rate agreements, and assisting with the implementation and review of new MAC tables and appeals. The role also requires communicating MAC prices of new drugs to team members.

Requirements

• Bachelor’s degree in Finance, Economics or other business-related field, or 4+ years of financial or pricing analysis experience in PBM or Healthcare related field preferred.
• Demonstrate expanded understanding of advanced Excel functionality preferred.
• Aptitude to learn or demonstrated understanding of databases and query languages (e.g., SQL, DBF, Access, SAS, etc.) preferred.
• Ability to effectively communicate, verbally and in writing, potentially technical information to a non-technical audience preferred.
• Ability to work independently and in a fast-paced environment preferred.
• Strong analytical and problem-solving skills preferred.

Responsibilities

• Analyze pharmacy claims data utilization to identify financial trends, opportunities, and potential risks, including changes to profit margins.
• Work with Pharmacy Network to identify new contract requirements and methods to validate set up in the system.
• Perform scheduled review and quality assurance of reimbursement in the system.
• Assist the legal team by monitoring, understanding, and acting on state MAC laws.
• Monitor and maintain contractual Generic Effective Rate agreements.
• Assist with implementation of new MAC tables for new clients.
• Assist with MAC review appeals from pharmacies & clients.
• Communicate MAC prices of new drugs with other team members.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level