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CVS Health

Runs pharmacies, health plans and clinics

Industry Analysis Coordinator - Industry Analysis

Business OperationsPosted on Nov 11
Full-timeRemote

About the Job

Requirements

  • At least 1 year of professional work experience in pharmacy claims.
  • At least 1 year of experience with Microsoft Office.
  • High school diploma or equivalent GED.

Responsibilities

  • Support all aspects of Maximum Allowable Cost (MAC) list maintenance and analysis, including creating new MAC lists, managing existing MAC lists, uploading MAC pricing to the adjudication platform, and performing MAC-related quality control activities.
  • Work with the Finance Guarantee team to help meet client commitments through appropriate MAC pricing adjustments.
  • Review and respond to pharmacy MAC appeals, and collaborate with the Legal team on MAC-related inquiries and complaints from state agencies.
  • Monitor pharmacy GER guarantees to identify and recommend pricing adjustments as needed.
  • Prepare and distribute client and pharmacy reports, supporting MAC-related reporting activities and ensuring pricing accuracy, regulatory compliance, and timely resolution of pharmacy inquiries.
  • Review and resolve MAC pricing inquiries from pharmacies in both MAC law and non-MAC law states, complying with MAC law requirements.
  • Validate information from sources including Medi-Span, manufacturers, and wholesalers.
  • Update the Pharmacy Inquiry Database accurately and respond to pharmacies within required turnaround times.
  • Identify marketplace condition changes and promptly forward potential issues to pharmacists for review to minimize impact on pharmacies and plan members.
  • Maintain the MACPRICE email box and respond to pharmacy phone calls as required by state laws.

Desired Qualifications

  • Experience with RxClaim.
  • Bachelor's degree.
  • Experience with Access Database.
  • Experience with SAS.

About the Company

CVS Health

Runs pharmacies, health plans and clinics

CVS Health runs pharmacies, health insurance plans and medical clinics for individuals, employers and government programs across the United States. Its businesses include CVS Pharmacy, the Aetna insurer and Caremark, which manages prescription coverage and negotiates drug prices for health plans. Patients fill prescriptions in stores or by mail and receive care through walk-in clinics, primary care centers and home visits. The company earns money from prescription sales, insurance premiums, plan administration fees and clinical services, combining coverage with places to obtain treatment. Its first store opened in 1963, and its headquarters are in Woonsocket, Rhode Island.

Company size
10,001+
Company stage
IPO
Headquarters
Woonsocket, Rhode Island
Founded
1963

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