Compensation Overview

$70,000 - $90,000Annually

Mid

Princeton, NJ, USA

Required Skills

Communications

Requirements

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
Experience as a user of multiple business software applications and advanced working knowledge of key business applications and claims adjudication systems
Strong business acumen, analytical skills, written and oral communication skills

Responsibilities

Utilizing planning, prioritizing, and organizational skills to manage formularies, tools, and processes
Analyzing claims adjudication results and identifying discrepancies
Troubleshooting and mitigating reported claims defects
Researching clinical and claims related inquiries
Maintaining plan formularies in claims processing system
Executing formulary changes per client intent
Assisting with implementations and supporting formulary builds
Completing special projects and assignments
Actively participating in cross-functional workgroups, teams, and committees
Ensuring timely deliverables, high levels of quality, and efficient use of resources
Maintaining a knowledge base of RxSense standard offerings and services

RxSense is a high-growth healthtech company empowering clients and consumers with technology to access lower cost prescription drugs. Its transformative cloud-based enterprise platform enables clients to take control of their pharmacy benefits with fast, flexible and customizable solutions and real time data insights to improve operational and financial performance -- and ultimately deliver better care to patients nationwide. RxSense also owns and operates SingleCare, a free prescription savings service that offers consumers access to consistently low prices on prescription drugs. Through its partnerships with the country’s largest pharmacies and grocers, including CVS, Walgreens, Walmart, Kroger and Albertsons, SingleCare improves access and adherence to more affordable medications and has helped millions of Americans collectively save over $8 billion on their medications.

RxSense is a great place to work! Our company has earned recognition as one of 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.

JOB SUMMARY:

You will be 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.

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.
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.

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.

Salary Range: $70,000 - $90,000

RxSense believes that a diverse workforce is a more talented and productive workforce. As such, we are an Equal Opportunity and Affirmative Action employer. Our recruitment process is free from discriminatory hiring practices and all qualified applicants are considered for employment without regard to race, color, religion, sex, gender, sexual orientation, gender identity, ancestry, age, or national origin. Neither will qualified applicants be discriminated against on the basis of disability or protected veteran status. We believe in the strength of the collaboration, creativity and sense of community a diverse workforce brings.

RxSense

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Website

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RxSense offers RxIQ Enterprise, a leading analytics and adjudication platform for pharmacy benefits management, leveraging advanced technologies such as API-based interoperability and real-time analytics to empower PBMs with flexible, efficient, and transparent pharmacy benefits administration. The platform also features lightning-fast claims adjudication, providing real-time control and actionable insights for pharmacy ecosystem management.

Company Stage

Private

Total Funding

N/A

Headquarters

Boston, Massachusetts

Founded

2015

Growth & Insights

Headcount

6 month growth

↑ 3%

1 year growth

↑ 10%

2 year growth

↑ 32%