Analyst, Government Pricing

🕒 il y a 2 mois

🐻 Alaska, Hawaii, +11 états de plus – Distant

🐻 Alaska – Remote 🌺 Hawaii – Remote 🦞 Maine – Remote 🗻 New Hampshire – Remote 🌶️ New Mexico – Remote 🌾 North Dakota – Remote 🎸 Mississippi – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote ⚔️ Virginia – Remote ⛰️ West Virginia – Remote 🦬 Wyoming – Remote

💵 $61 968 - $74 660 / an

⏰ Temps Plein

🟡 Intermédiaire

🟠 Senior

🧐 Analyste

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Navitus Health Solutions

Site WebLinkedInTous les Emplois

1001 - 5000 employés

Fondée en 2003

⚕️ Assurance santé

💊 Pharmaceutique

🤝 B2B

Healthcare Insurance • Pharmaceuticals • B2B

Navitus Health Solutions est un gestionnaire de prestations pharmaceutiques (PBM) qui propose des solutions transparentes et centrées sur les personnes pour les prestations pharmaceutiques, à destination des régimes de santé, des employeurs, des programmes gouvernementaux et d'autres parrains de régimes. L'entreprise opère sur un modèle de passage intégral à un coût majoré, qui met l'accent sur la réduction des coûts des médicaments, la gestion des formulaires, la gestion des médicaments spécialisés (y compris une pharmacie spécialisée à coût majoré), l'évaluation des réclamations, la gestion du réseau de pharmacies, ainsi que l'activation et le support des membres. Navitus se positionne comme un partenaire fiduciaire axé sur l'accessibilité, la conformité, la qualité clinique, et l'amélioration des résultats de santé grâce à des services PBM sur mesure et à des intégrations de santé numérique.

Description

• Maintain and administer Medicaid fee for service drug pricing methodologies in accordance with federal and state Medicaid requirements. • Monitor and incorporate National Average Drug Acquisition Cost (NADAC) updates and related CMS guidance into pricing models and operational systems. • Evaluate and apply HRSA 340B ceiling price considerations and exclusions as applicable to Medicaid reimbursement models. • Ensure pricing methodologies align with state specific Medicaid reimbursement rules and contractual requirements. • Accountable to cross-walk FDB to Medispan or visa versa to ensure compliance with State Medicaid Prescription Drug List and ensure ongoing reconciliation and updates. • Support compliance with federal and state audit, reporting, and transparency expectations related to Medicaid drug pricing. • Maintain and manage industry pricing and reference sources, including but not limited to Medi Span multisource and product codes (e.g., MONY indicators), NADAC pricing files, and HRSA 340B ceiling price date. • Validate integrity, completeness, and timeliness of reference data used in pricing and modeling and resolve or escalate discrepancies. • Assess industry changes that may impact Medicaid pricing assumptions or reimbursement outcomes. • Maintain, and update financial models supporting Statements of Work (SOWs) for Medicaid fee for service pricing arrangements. • Perform detailed pricing impact analyses to support SOW development, amendments, and renewals. • Manipulate and analyze large data sets specific to SOW requirements, pricing guarantees, and reimbursement terms. • Partner with internal stakeholders to ensure SOW pricing assumptions are accurate, documented, and supportable. • Other duties as assigned.

🎯 Exigences

• Bachelor’s degree in Finance, Economics, Healthcare Administration, Data Analytics, or related field, or equivalent work experience, required. • 3+ years of experience in PBM, Medicaid pharmacy programs, managed care, healthcare analytics, or pricing analysis required. • Experience preparing documentation, reporting, and analysis to support internal reviews, regulatory inquiries, audits, and client requests required. • Experience supporting Medicaid fee‑for‑service drug pricing methodologies in alignment with federal and state Medicaid requirements preferred. • Experience working with industry pricing and reference sources, including Medi Span multisource and product codes (e.g., MONY indicators), NADAC pricing files, and HRSA 340B ceiling price data preferred. • Experience conducting pricing impact analyses and maintaining financial models to support Medicaid Statements of Work (SOWs), amendments, and renewals preferred. • Participate in, adhere to, and support compliance program objectives. • The ability to consistently interact cooperatively and respectfully with other employees.

🏖️ Avantages

• Health insurance • 401K company match of up to 5% - No vesting requirement • 20 days paid time off • 4 weeks paid parental leave • 9 paid holidays • Adoption Assistance Program • Flexible Spending Account • Educational Assistance Plan and Professional Membership assistance • Referral Bonus Program – up to $750!