Formulary Operations Analyst

June 1

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RxSense

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Advanced Technologies. Powerful Results.

201 - 500

💰 Private Equity Round on 2020-05

Description

• Implementing, maintaining and evaluating formularies for clients and pharmacies in RxIQ. • Utilizes planning, prioritizing, and organizational skills to effectively manage formularies, tools, and processes necessary to achieve business objectives. • Analyzes claims adjudication results and identifies discrepancies, inaccuracies and anomalies. • Troubleshoots and mitigates reported claims defects. • Research clinical and claims related inquiries from RxSense clients and internal departments. • Maintains plan formularies in claims processing system and confirms coding changes have been completed and implemented accurately. • Execute formulary changes per client intent to ensure formularies will adjudicate at point-of-sale as expected. • Maintains, facilitates access to, and distributes member documents and websites. • Assists with implementations – gathering and documenting requirements and supporting formulary builds. • Completes special projects and assignments (such as documenting processes and procedures and facilitating with internal and external training. • Actively participates as a key member of cross functional workgroups, teams, and committees as assigned. • Ensures timely deliverables, high levels of quality, and efficient use of resources. • Maintains a knowledge base of RxSense standard offerings and services.

Requirements

• Bachelor’s degree preferred or equivalent work experience. • Previous experience with formulary operations, pharmacy claims processing and familiarity with analytical methods is preferred. • Strong knowledge of PBM drug data management. • Advanced knowledge of Microsoft Office Suite to create complex documents and analyze data. • Experience as a user of multiple business software applications and advance working knowledge of key business applications and claims adjudication systems. • Strong business acumen, analytical skills, written and oral communication skills.