The Pricing Operations Analyst II is responsible for creating, analyzing, researching, automating and making suggestions for various pricing schedules, Maximum Allowable Cost (MAC) lists, and executive level reporting by coordinating with pharmacy benefit management (PBM) and mail order operations. **
Essential Duties And Responsibilities**
Prepare and maintain generic pricing throughout the MAC list across all lines of business in compliance with pharmacy network contracts to drive bottom line value
Execute the MAC appeal process by consolidating data, researching industry pricing, and evaluating research and pricing proposals for appropriateness, accuracy, and impact
Update MAC lists in adjudication system and provide quality assurance of other system changes as necessary
Complete mail order pricing reports to determine the usefulness of rates and margins
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
Determine the impact of weekly price changes as well as periodic changes to manufacturer contracts
Provide support as needed on relevant MAC processes and projects to dive bottom line value
Establish, maintain and support automated systems and processes to increase productivity
Generalize data structures and processes to facilitate improvements to efficiency through automation
Verify that claims performance adheres to the effective rate strategy and examine deviations from the target rate and prepare adjustments when necessary and work directly with Pharmacies on resolving conflicts
Research industry trends on pricing, brand to generic changes, bio-similar product releases and Food and Drug Administration (FDA) and Drug Enforcement Administration (DEA) decisions
Monitor drug shortages and potential price increases to generate cost savings and avoid potential financial liability
Create, maintain, and distribute shortage reports to the appropriate parties
Monitor new generic drug entrance 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 a timely manner
Assess and validate claim adjudication setups by pharmacy and by client and investigate sources of discrepancies
Review and prepare claims data uploads for external auditors
Conduct special studies and investigations and report findings to department leaders
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 2 – 3 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 work with peers in a team effort
Demonstrated ability to manage multiple priorities and deadlines
Capability to efficiently complete tasks in a fast paced environment
Ability to work extended hours, weekends and holidays pursuant with industry demands
Proficient in Microsoft Office and industry related software programs **
Preferred Qualifications**
Masters 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 **
Education Requirements**
Education Level
GED
Bachelor Degree
Area of Specialization
business, mathematical, statistical, financial, or applied science discipline strongly preferred; proven industry experience will be acceptable in lieu of degree **
LICENCES/CERTIFICATIONS**
Not Applicable **
Experience**
WORK EXPERIENCE
pricing, finance or with a PBM
The typical starting pay range for this position is between $59,500-$83,875, although wages can vary based on experience and geography.
