Pharmacy Network Operations Analyst

Summary

Pharmacy Data Management, Inc. (PDMI) provides pharmacy data processing and related services for pharmacy benefit managers, health plans, and healthcare systems. The Pharmacy Network Operations Analyst supports the analysis, maintenance, and optimization of pharmacy and client networks, including network design, pricing strategies, MAC operations, reporting, audits, and issue resolution.

Responsibilities

• Acquire and maintain a strong understanding of the pharmacy network structure, rates, MAC pricing, provider demographics, and related operational components
• Assist in maintaining and updating pharmacy network design, pharmacy demographic data, MAC operations, reimbursement methodologies, and network-related system updates
• Provide guidance on pricing strategies, and implementation considerations for pharmacy reimbursement
• Conduct research and analysis on claims, pharmacy inquiries, MAC-related issues, and other pricing or reimbursement discrepancies
• Develop and maintain operational audit tools, provide corrective action follow-up, and support audit activities across the network
• Create analytical and operational reports related to network performance, MAC activity, Audit claims, pharmacy operations, and client-specific requests
• Lead or support ad-hoc analysis and reporting to assist internal stakeholders in network decision-making
• Assist with establishing and updating procedures related to accurate claims adjudication and network maintenance
• Participate in policy and procedure development for Pharmacy Network operations and support continuous improvement initiatives
• Build collaborative relationships with internal departments to ensure accurate implementation of network contracts, pricing, and related updates

Skills

• Bachelor's degree in Health Administration, Healthcare Analytics, Business, Finance, or a related field or equivalent industry experience required
• Database development and reporting experience using SQL, TOAD, or similar tools required
• Strong data analysis and data manipulation skills required
• 3+ years of pharmacy network experience preferred
• Pharmacy data analysis experience preferred

Qualifications

Must Haves

• Bachelor's degree in Health Administration, Healthcare Analytics, Business, Finance, or a related field or equivalent industry experience required
• Database development and reporting experience using SQL, TOAD, or similar tools required
• Strong data analysis and data manipulation skills required

Nice to Haves

• 3+ years of pharmacy network experience preferred
• pharmacy data analysis experience preferred

Benefits

• Fully remote opportunity
• Meaningful work contributing to improving healthcare quality and efficiency
• Collaborative environment with passionate professionals
• Exciting challenges and new opportunities to excel