Formulary Operations Analyst

JOB SUMMARY:

You will be responsible for implementing, maintaining and evaluating formularies for clients and pharmacies in RxIQ, the adjudication platform of RxSense. This critical role bridges the technology platform and formulary (clinical) objectives.

PRIMARY JOB DUTIES & RESPONSIBILITIES:

• 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.

Education and/or Experience:  

• 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.

Salary Range: $70,000 - $90,000