Formulary Operations Analyst

Job Description

• 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 • 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

Qualifications

• 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

Benefits

• Fast Company’s Most Innovative Companies, Forbes’ Top Startup Employers, Modern Healthcare's Best Places to Work in Healthcare, and Inc’s Best in Business and Best Workplaces