Reimbursement Analyst

PRINCIPLE RESPONSIBILITIES (include but are not limited to):

• 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.

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.

PHYSICAL DEMANDS

Requires sitting, standing, and occasional light lifting.

The Perks of Joining Our Team:

We believe in taking care of our team. You'll enjoy a comprehensive benefits package designed to support your well-being and financial future:

• Comprehensive Health Benefits: Medical, Dental, Vision, Short-Term/Long-Term Disability Insurance, Life insurance.
• Time to Recharge: Paid vacation and holiday pay.
• Focus on Your Wellness: We offer a robust Employee Wellness Program.
• Invest in Your Future: 401 k with a company match.
• Support System: Employee Assistance Program provides confidential support and counseling.
• Get Rewarded for Referring Great People: Employee referral program.

ProCare Rx will never ask for a financial commitment from an applicant, as part of our recruitment process. All interviews are conducted in-person OR through video conference invitations from official company emails. For inquiries, please contact our official recruitment team at [email protected].

ProCare Rx is an Equal Opportunity Employer.