Formulary Operations Analyst

Vaga não está no LinkedIn

🕒 Maio 29

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $75.000 - $85.000 / ano

⏰ Tempo Integral

🟢 Júnior

⚙️ Operações

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RxSense

SiteLinkedInTodas as Vagas

201 - 500 funcionários

⚕️ Seguro de Saúde

💊 Farmacêutico

☁️ SaaS

💰 Private Equity Round em 2020-05

Healthcare Insurance • Pharmaceuticals • SaaS

A RxSense é uma empresa HealthTech dedicada à modernização do gerenciamento de benefícios farmacêuticos. Eles desenvolvem produtos de ponta que otimizam a adjudicação e análise de sinistros, visando reduzir custos e melhorar o acesso dentro do ecossistema farmacêutico. A RxSense oferece soluções para PBMs, farmácias, fabricantes de produtos farmacêuticos, pagadores e consumidores, apoiando melhores resultados para milhões de pessoas diariamente. Seus produtos incluem ferramentas avançadas como o motor de adjudicação RxIQ Enterprise, uma plataforma de análise de inteligência de negócios e otimização de preços baseada em IA. Eles são conhecidos pela sua marca principal de economia em prescrições, SingleCare, que ajuda os consumidores a garantir preços acessíveis, beneficiando parceiros farmacêuticos.

Descrição

• Configure, update, and maintain custom and standard formularies within the claims adjudication system. • Ensure accuracy and alignment of formulary builds with client intent, clinical strategy, and regulatory requirements. • Troubleshoot adjudication issues and discrepancies; conduct detailed analysis to resolve defects and anomalies. • Participate in client implementations by gathering and documenting formulary requirements. • Serve as a clinical capabilities subject matter expert. • Collaborate with internal teams to ensure smooth integration of formulary solutions. • Perform audits to validate formulary configuration accuracy. • Monitor claim processing to detect and correct potential issues proactively. • Assist in analyzing and presenting data related to formulary performance or disruptions. • Pull, organize, and aggregate data and reports to support client meetings and formulary strategy presentations. • Support client interactions as needed, including responding to formulary-related inquiries and assisting in training sessions. • Work closely with clinical partners to ensure translation of clinical direction into accurate system configuration. • Contribute to development and documentation of internal workflows, best practices, and training materials. • Lead or contribute to special initiatives such as process optimization, disruption analyses, or platform enhancements. • Recommend and implement improvements to ensure greater accuracy, efficiency, and scalability of formulary operations.

🎯 Requisitos

• Bachelor’s degree or 1 year equivalent experience in healthcare (PBM) • 1+ year's of experience in formulary operations, pharmacy claims adjudication, or related healthcare analytics. • Demonstrated expertise in configuring and maintaining formulary data within claims systems. • Excellent working knowledge of formulary structures, Medispan/FDB data, and pharmacy benefit operations. • Strong problem-solving skills with the ability to analyze data and translate findings into actionable solutions. • Detail-oriented, with the ability to manage multiple priorities and meet deadlines. • Superior written and verbal communication skills — clear and concise with both internal and client-facing audiences. • Excellent organizational and time management skills. • Ability to take the lead on projects and follow through to completion. • Proficiency in Microsoft Excel and advanced knowledge of Microsoft Office Suite to create complex documents and analyze data. • Self-starter with a proactive mindset and a high level of accountability.