Job Location: Remote
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Create and maintain generic pricing through MAC lists, in the adjudication system, across all lines of business, in compliance with pharmacy and Client contracts
- Provide quality assurance of other system changes as necessary
- Execute the MAC appeal process by consolidating data, researching industry pricing, and evaluating research and pricing proposals for appropriateness, accuracy, and impact
- Report on discount card performance such as changes in product utilization, volume, discount rates, usual and customary rates, and market share to Elixir Savings Management
- Provide support as needed on relevant MAC processes and projects to drive bottom line value
- Establish, maintain, and support automated processes to increase productivity
- Verify that claims performance adheres to the effective rate strategy, examine deviations from the target rate and prepare adjustments when necessary
- Research industry trends on pricing, brand to generic changes, bio-similar product releases, Food and Drug Administration (FDA) and Drug Enforcement Administration (DEA) decisions
- Monitor new generic drug entrance to market and changes in availability to create and update pricing based on changing market conditions to enhance Client savings
- Perform effective rate reporting for Executive Management to ensure that both corporate goals and contractual obligations are met
- Respond to pricing inquiries from business partners in an accurate and timely manner
- Assess and validate claim adjudication setup for both Pharmacies and Clients, and investigate any discrepancies
- Collaborate with cross-functional teams for both Pharmacy and Client audits
- Conduct complex analyses, both self-initiated and assigned, in order to ensure corporate financial goals are met
- Create and maintain visually stimulating financial dashboards to track and present key metrics to executive leadership
- Create and maintain clear and concise documentation for current and future processes
- Incorporate data and insights from various sources to develop clear and actionable recommendations that will further financial strategies and support corporate financial goals
- Analyze data to identify and validate both financial risks and opportunities and drive action to address
- Assist in training and development of new hires and cross-functional team members
- Other duties as assigned
REQUIREMENTS:
- Bachelor’s degree in business, mathematical, statistical, financial, or applied science discipline strongly preferred; proven industry experience will be acceptable in lieu of degree
- Minimum 4 – 5 years relevant pricing or finance experience preferred, preferably with a PBM
- Financial and statistical reporting knowledge and experience
- Effective verbal and written communication skills
- A decisive individual who possesses a detail-oriented perspective
- A strategic planner with sound technical skills, analytical ability, good judgment, and strong operational focus
- Ability to collaborate with team members
- Demonstrated ability to manage multiple priorities, meet deadlines, and complete tasks accurately and efficiently in a fast-paced environment
- Ability to work extended hours, weekends, and holidays pursuant with industry demands
- Proficient in Microsoft Office (particularly Excel) and other industry related software programs
- An intelligent and articulate individual who can relate to people at all levels of an organization and possesses excellent communication skills
- Strong problem-solving skills and ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
- Self-motivated individual who is able to work with minimal supervision
PREFERRED QUALIFICATIONS:
- Master’s degree
- A knowledgeable individual with appropriate industry experience, preferably in the healthcare, insurance or PBM industry
- MS Access, VBA, or SQL programming knowledge and experience
WORK ENVIRONMENT:
Includes both a typical office environment, with minimal exposure to excessive noise or adverse environmental issues, and occasional local and/or overnight travel, including exposure to heat, cold, and inclement weather conditions. Mode of transportation for travel typically will include automobile and plane.
PHYSICAL REQUIREMENTS:
Ability to sit for prolonged periods of time
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)
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