Reimbursement Analyst

PRINCIPLE RESPONSIBILITIES (include but are not limited to):

• Analyze pharmacy claims data utilization to identify financial trends, opportunities, and potential risks, including changes to profit margins.
• Work with Pharmacy Network to identify new contract requirements and methods to validate set up in the system.
• Perform scheduled review and quality assurance of reimbursement in the system.
• Assist the legal team by monitoring, understanding, and acting on state MAC laws.
• Monitor and maintain contractual Generic Effective Rate agreements.
• Assist with implementation of new MAC tables for new clients.
• Assist with MAC review appeals from pharmacies & clients.
• Communicate MAC prices of new drugs with other team members.

REQUIREMENTS

• Bachelor’s degree in Finance, Economics or other business-related field, or 4+ years of financial or pricing analysis experience in PBM or Healthcare related field preferred.
• Demonstrate expanded understanding of advanced Excel functionality preferred.
• Aptitude to learn or demonstrated understanding of databases and query languages (e.g., SQL, DBF, Access, SAS, etc.) preferred.
• Ability to effectively communicate, verbally and in writing, potentially technical information to a non-technical audience preferred.
• Ability to work independently and in a fast-paced environment preferred.
• Strong analytical and problem-solving skills preferred.

PHYSICAL DEMANDS

Requires sitting, standing, and occasional light lifting.

The Perks of Joining Our Team:

We believe in taking care of our team. You'll enjoy a comprehensive benefits package designed to support your well-being and financial future:

• Comprehensive Health Benefits: Medical, Dental, Vision, Short-Term/Long-Term Disability Insurance, Life insurance.
• Time to Recharge: Paid vacation and holiday pay.
• Focus on Your Wellness: We offer a robust Employee Wellness Program.
• Invest in Your Future: 401 k with a company match.
• Support System: Employee Assistance Program provides confidential support and counseling.
• Get Rewarded for Referring Great People: Employee referral program.

ProCare Rx will never ask for a financial commitment from an applicant, as part of our recruitment process. All interviews are conducted in-person OR through video conference invitations from official company emails. For inquiries, please contact our official recruitment team at View email address on click.appcast.io.

ProCare Rx is an Equal Opportunity Employer.

Equal Opportunity Employer


This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.