Pharmacy Program Optimization Analyst

Job Description

Job Description

Pharmacy Program Optimization Analyst

Full Time 

Columbus, Ohio 

AndHealth is on a mission to radically improve access and outcomes for the most challenging chronic health conditions with the goal of making world-class specialty care accessible and affordable to all. We partner with health systems, community health centers, and independent practices to remove barriers to care to ensure all people have access to the care they deserve.

We are looking for a Pharmacy Program Optimization Analyst who will play a critical role in maximizing the efficiency and effectiveness of our partner’s federal drug pricing programs. This individual will move beyond traditional compliance, focusing on identifying and implementing opportunities for significant program enhancement and revenue capture across multiple pharmacy claim initiatives.

What you’ll do in the role:

• Proactively monitor Pharmacy claims across our partners, identifying trends, anomalies, and areas of opportunity to improve claim capture. Identify and address missing claim data, working collaboratively with FQHC partners, TPAs, and pharmacy operations teams to investigate root causes of unpaid or uncaptured claims and implement sustainable long-term solutions to improve paid claim rates. Investigate carve-out logic and payer carve-out status to ensure pharmacy claims are submitted under the appropriate billing configuration and compliance.
• Stay current with evolving manufacturer contract pharmacy policies and their potential impact on program optimization, adapting strategies as needed.
• Analyze data from EHRs,TPAs and pharmacy operating systems to track and confirm program eligibility and utilization, identifying opportunities for improved capture.
• Troubleshoot live issues related to EHR and pharmacy operating systems that affect program eligibility or optimization.
• Establish and maintain strong relationships with internal and external providers and partners to support program workflows and drive efficiency.
• Create, update, and contribute to the development of program policies and procedures, with an emphasis on optimization.
• Track and analyze monthly savings, and trends to drive financial optimization of the program.
• Generate reports to support audit processes, leadership visibility, and budget forecasting, highlighting optimization efforts and outcomes.
• Stay current on claims reimbursement policies and best practices; attend training, webinars, and conferences as needed, applying new knowledge to program enhancement.
• Review HRSA OPAIS website and notify internal stakeholders and advise partners on changes required for program optimization and compliance.
• Participate in internal and external meetings regarding eligibility, process improvement, and quality, focusing on optimization strategies.
• Perform other duties as assigned to support program growth and efficiency.

Education & Licensure Requirements:

• Bachelor's degree in Computer Science, Economics, Engineering, Mathematics, or a related quantitative field, or equivalent practical experience preferred.

Other Skills or Qualifications:

• Proven experience with federal drug pricing program operations and a strong understanding of paid claims workflow and optimization strategies.
• Mastery of Microsoft Excel and other analytics tools for advanced data manipulation, analysis, and reporting.
• Exceptional problem-solving skills, with a demonstrated ability to identify complex issues, conduct root cause analysis, and implement effective, long-term resolutions.
• Ability to proficiently use EHR and pharmacy operating system(s).
• Exceptional organization skills and ability to manage competing priorities in a fast-paced environment
• Ability to work independently and take initiative in solving problems and improving processes
• Strong attention to detail, spelling, and numerical differences.
• Exemplary written and verbal communication skills.
• Knowledge of healthcare terminology.
• Nice to have: Experience with SQL for advanced data querying and analysis.

Here’s what we’d like to offer you:

• Equal investment and support for our people and patients.
• A fun and ambitious start-up environment with a culture that takes on important things, takes risks, and learns quickly.
• The ability to demonstrate creativity, innovation, and conscientiousness, and find joy in working together.
• A team of highly skilled, incredibly kind, and welcoming employees, every one of whom has something unique to offer.
• We know that the overall success of our business is a collaborative effort, and we strive to provide ongoing opportunities for our employees to learn and grow, both personally and professionally.
• Full-time employees are eligible to participate in our benefits package which includes Medical, Dental, Vision Insurance, Paid time off, Short- and Long-Term Disability, and more.

We are an equal opportunity and affirmative action employer. We embrace diversity and are committed to creating an inclusive environment for all employees. Applicants will be considered for employment without regard to race, religion, gender, gender identity, sexual orientation, national origin, age, disability, or veteran status.

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