Formulary Operations Analyst, Enterprise Platform Services

JOB SUMMARY:

RxSense is a forward-thinking, growth-oriented healthcare services and technology company that provides state of the art pharmacy solutions. The Formulary Operations Analyst in the Enterprise Platform Services division will report to the VP of Formulary Operations and will be responsible for implementing, maintaining, and evaluating formularies for clients and pharmacies in RxAgile, 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
• Researches 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 work groups, 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

DESIRED KNOWLEDGE, SKILLS, & ABILITIES:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.

• Excellent working knowledge of pharmacy benefit administration
• Proficient ability to own the success of projects with minimal supervision using sound judgment, while maintaining a professional and positive demeanor
• Must be able to develop and maintain strong working relationships on a multi-level basis
• Superior written and verbal communication skills - ability to communicate information & ideas clearly & concisely
• Ability to foster a positive and creative work environment
• Ability to work in a dynamic fast-paced atmosphere
• Ability to maintain confidentiality
• Ability to work under tight deadlines