The Pharmacy Network Operations Analyst is responsible for various operational aspects of support, analysis, and quality assurance in pharmacy network design and administration. The position is responsible for monitoring the pharmacy network, rate analysis, utilization, maintenance and issue resolution.

Responsibilities:

  • Ability to demonstrate, understand and apply our workplace mission, vision and values

Operations (70%):

  • Gain a thorough understanding of the Pharmacy Network, including rates, MAC pricing, etc.
  • Assist in the maintenance and updating of Pharmacy Network design
  • Assist in maintenance and updating of pharmacy demographic information
  • Assist in MAC system updates
  • Assist in MAC operations and implementation in procedures
  • Assist with claim reimbursement inquiries
  • Provide guidance on pricing and repricing development and implementation strategies
  • Develop operational auditing tools for analysis and corrective action follow up
  • Assist in establishing procedures related to the accurate adjudication of claims
  • Assist in the development of audit tools for analysis and corrective action follow up
  • Other duties as required

Data Analysis (20%):

  • Create analytical and operational reports to analyze network development and maintenance
  • Perform ad-hoc reporting on MAC, pharmacy, and client performance
  • Provide support in various analysis requests

Corporate Development (10%):

  • Develop policies and procedures for applicable Pharmacy Network activities
  • Build relationships with internal staff to ensure contract implementations are carried out correctly
  • Continued education as necessary

Work & Education Experience Requirements:

  • Bachelor’s degree in a related field (health administration, healthcare analytics, business, finance) is required; proven industry experience in the same role may be acceptable in lieu of degree
  • Minimum of three years of prior pharmacy network experience
  • Strong data manipulation skills
  • Database development and reporting using SQL as well as other tools
  • Ability to develop a unique understanding of PDMI brand, products, and services
  • Excellent Microsoft Office skills, including Outlook, Teams, Excel, Word, and PowerPoint

Competencies, Skill and Other Requirements:

  • Very strong attention to detail
  • Thoroughly executes all aspects of assigned tasks and responsibilities
  • Excellent organizational and time management skills
  • Ability to function effectively and professionally in a fast-paced environment
  • Ability to multi-task, managing multiple projects/priorities daily
  • Troubleshooting skills
  • Excellent research skills, follow-up skills, documentation skills, and issue-resolution skills
  • Strong business acumen and financial understanding
  • Prioritize quality
  • Unique integrated knowledge of the PDMI product and client services
  • Results-oriented mind set
  • Motivated and task-oriented
  • Strong verbal and written communication skills
  • Ability to communicate effectively with all levels within an organization
  • Excellent presentation skills, with the ability to present to groups
  • Ability to self-develop as rules, regulations, and industry standards change regularly
  • Some overnight travel may be required