Pharmacy Reimbursement Analyst - 139081

Pharmacy Reimbursement Analyst - 139081

The Pharmacy Analyst supports retail pharmacy operations by analyzing financial, operational, and clinical data to improve performance, control costs, ensure regulatory compliance, and optimize patient access and service delivery. This role partners with pharmacy leadership, finance, operations, and IT teams to provide insights that drive data-informed decision-making across retail pharmacy locations.

Responsibilities include:

• Pharmacy workflows: prescription life cycle, roles and responsibilities of pharmacy personnel as well as scope of practice, medication access.
• Pharmacy finance and business models: third party billing, PBM contract and reimbursement models, Part D plan design.
• Specialty pharmacy: LDD access, biosimilars, patient assistance programs, cash flows and margins.
• Regulatory & compliance: Medicare, Medicaid, 340b program, predictive analysis, dashboards
• Business Intelligence: Advanced Excel, SQL, Data QA, Python.
• Health Information Systems: EPIC/ WAM, claims reconciliation platforms, accounts receivable.
• Automation: RPA, Automation impact analysis (pre and post deployment), automation impact analysis and prioritization of use cases.

Minimum Qualifications:

• Seven (7) years of related experience, education/training OR a Bachelor's degree in related area plus three (3) years of related experience/training. Related experience: Prescription lifecycle and reimbursement from payors and patient payment options.
• Demonstrated knowledge of healthcare reimbursement revenue cycle workflow, financial reporting, net revenue analysis and budgeting to effectively and independently capture revenue.
• Strong skills in data management and analysis.
• Ability to manage a project through from inception to completion on schedule while performing a wide variety of tasks, adapting to changing priorities, deadlines and directions.
• Thorough knowledge of financial analysis, research, and reporting, particularly as it applies to reimbursement in healthcare settings.
• Strong interpersonal skills, with the ability to collaborate effectively on complex projects in a team environment with staff from a wide variety of business and clinical areas.
• Strong communications skills, with the ability to interpret and convey finance information in a clear, concise manner. Ability to prepare compelling and informative reports and presentations.
• Ability to perform all commonly applicable functions in word processing and spreadsheet software.

Preferred Qualifications:

• Pharmacy Financial & Reimbursement Analytics experience: Prescription third party billing, PBM contract and reimbursement models, quality metrics.
• Specialty Pharmacy & High Cost Drug Management experience: Business intelligence experience - for example margins, capture, cost avoidance.
• Regulatory & Compliance Knowledge: Medicare, 340B, PHI/ HIPAA, CMS.
• Technical skills: Advanced Excel (pivot tables, formulas, Power Query), SQL or database querying, Predictive or trend analysis (claims patterns, reimbursement risk), Dashboard development (Power BI, Tableau, Epic SlicerDicer, etc.).
• Health Information Systems & Data Sources experience: EPIC/ WAM, Claims platforms.
• Automation & Process Improvement experience: RPA in workflow automation.
• Communication & Stakeholder Management experience i.e. Executive summaries, leadership reports.

Special Conditions:

• Must be able to work various hours and locations based on business needs.
• Employment is subject to a criminal background check and pre-employment physical.