What are the responsibilities and job description for the Reimbursement Analyst position at ProCare Rx?
SUMMARY
This role is responsible for managing and validating the company's pharmacy reimbursement methodologies including all contracted Rates and MAC (Maximum Allowable Cost) pricing.
PRINCIPLE RESPONSIBILITIES (include but are not limited to) :
- Analyze pharmacy claims data utilization to identify financial trends, opportunities, and potential risks, including changes to profit margins.
- Work with Pharmacy Network to identify new contract requirements and methods to validate set up in the system.
- Perform scheduled review and quality assurance of reimbursement in the system.
- Assist the legal team by monitoring, understanding, and acting on state MAC laws.
- Monitor and maintain contractual Generic Effective Rate agreements.
- Assist with implementation of new MAC tables for new clients.
- Assist with MAC review appeals from pharmacies & clients.
- Communicate MAC prices of new drugs with other team members.
REQUIREMENTS
PHYSICAL DEMANDS
Requires sitting, standing, and occasional light lifting.
ProCare Rx will never ask for a financial commitment from an applicant as part of our recruitment process. All interviews are conducted in-person OR through video conference invitations from official company emails. For inquiries, please contact our official recruitment team at (678) 248-4755 or email us at HR@procarerx.com.
ProCare Rx is an Equal Opportunity Employer.
