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Formulary Compliance Analyst # 26-25892

US Tech Solutions

Role overview

Qualifications

  • Thorough understanding of Managed Care contracting as it relates to formulary access and tier positioning
  • Minimum of 3 years’ experience in financial analysis
  • Bachelor's Degree in Finance or other business-oriented fields
  • Minimum of 2 years’ experience working with drug formularies

Responsibilities

  • Identify and resolve compliance and eligibility issues with contracted managed care customers
  • Establish an audit plan to review assigned account formularies across Commercial, Medicare Part D, and medical channels
  • Review products on each formulary and assess compliance with the stated terms and conditions of the contract
  • Complete complex investigational audit reviews and present findings to key stakeholders

Key facts

Hard skills

Other skills

  • Microsoft Excel
  • Microsoft PowerPoint
  • Negotiation
  • Critical Thinking

About the company

US Tech Solutions logo

US Tech Solutions

Staffing & Recruiting

USTECH SOLUTIONS is the largest privately owned diversity workforce partner with a global footprint. For 20+ years, we have partnered with leading MSPs and some of the world’s largest enterprises to deliver a flexible workforce. We serve Fortune 500 giants and growing businesses alike, reinventing the role of humans in a digital workforce. ‘Reinventing Human’ is about connecting you with top talent and seamlessly integrating new hires into your programs through our next gen AI powered Talent platforms. As the largest private diversity supplier in the US, we champion inclusion and unlock hidden potential. We work with leading MSPs and are a trusted strategic partner to the world’s top brands. At USTECH SOLUTIONS, we're inverting the talent hiring pyramid by offering a range of solutions from curated talent pools, workforce management services, and IT services resourcing to IC compliance. Our legacy and close affinity to the computing industry has equipped us with the expertise and vision to provision AI platform solutions that help organizations to innovate faster. Considering Statement of Work? Meet US Tech Digital (ustechdigital.com). We're helping businesses achieve digital leadership through our tailored SOW solutions, utilizing market-leading technology products and our proprietary in-house developed platform solutions. Explore our full range of services and solutions by visiting our website: ustechsolutions.com

Company details

Company typeLarge
IndustryStaffing & Recruiting
Company size1001 - 5000

Links

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Job description

Duration: 03 months with possible extension

Job Description:
  • The purpose of the position is to identify and resolve compliance and eligibility issues with contracted managed care customers. This position works with the Market Access account managers and the contracted account to gain alignment on formulary product placement and compliance and to recover previously paid rebate or discounts in the event of noncompliant formulary findings.
  • Reporting to the Senior Manager, Contract & Formulary Compliance, the incumbent will be responsible for identifying and investigating formulary positions on PBM and Health Plan websites and formal Pharmacy Drug Lists (PDL) to validate product placement comply with all terms and conditions of the managed care contract. Using critical thinking skills and data analytics, the incumbent will complete complex investigational audit reviews, identify risks and compliance issues and present findings both verbally and in writing to key internal and external stakeholders.
How you’ll spend your day
  • Establish an audit plan to review assigned account formularies across Commercial, Medicare Part D, and medical channels
  • Review products on each formulary and assess compliance with the stated terms and conditions of contract; request and obtain supporting documentation (e.g., prior authorizations, step edits etc.) as needed to complete the assessment.
Core Essential Skill Set:
Required:
  • Thorough understanding of Managed Care contracting as it relates to formulary access and tier positioning; Industry understanding of step-edits, NDC blocks, prior authorizations, copay differentials, preferred and non-preferred status is a plus
  • Ability to articulate a comprehensive understanding of contract terms and conditions
  • Advanced understanding of pharmaceutical rebate flow and decision points
  • 340B knowledge is a plus
  • Minimum of 3 years’ experience in financial analysis
  • Minimum of 2 years’ experience working with drug formularies
  • Superior skills in Excel and PowerPoint
  • Pharma Experience is a must.
  • Managed Care experience rather than rebate experience.
Preferred:
  • Experience in brand pharmaceutical business, specifically in market access, rebate operations, and/or pharma contract compliance
  • Strong negotiation and presentation skills
  • Understanding of drug purchase discounts and their interaction with Rx based rebates
Education:
  • Bachelor's Degree in Finance or other business-oriented fields. This is a must.
 
 About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com.

US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

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Marcus Rivera

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