Position Summary:    

The Formulary Operations Analyst in the Enterprise Platform Services division will be the subject matter expert for RxSense’s standard formulary offerings and clinical programs. This role supports client implementations and formulary drug maintenance. The Formulary Operations Analyst will have an excellent working knowledge of RxSense products and processes and establish day to day relationships with cross functional areas. The role will require active engagement and involvement in client interactions including leading training sessions and serving as a bridge between the technology platform and clinical objectives. The Formulary Operations Analyst will report to the VP of Clinical Services and support clinical pharmacists.

Essential Duties and Responsibilities: 

• Develop a high degree of knowledge about pharmacy claims and RxSense claims platforms.
• Analyzes claims adjudication results and identifies discrepancies, inaccuracies and anomalies.
• Troubleshoots and mitigates reported claims defects.
• Researches 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.
• Executes formulary changes per client intent to ensure formularies will adjudicate at point-of-sale as expected.
• Maintains, facilitates access to, and distributes clinical 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 formulary disruptions analyses).
• 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.
• Build solid working relationships both internally and externally with clients.
• Communicate system enhancement requests effectively to development teams.  

Education and Experience:

• Bachelor’s degree or 5 + years equivalent experience in healthcare (PBM).
• Experience with pharmacy technology and claims processing.
• Strong Experience with Microsoft Suite.
• Must be able to develop and maintain strong working relationships on a multi-level basis.
• Superior written and verbal communication skills - ability to communicate information & ideas clearly & concisely both internal and external (client facing).
• Excellent organizational & time management skills.
• Ability to work in a dynamic fast paced atmosphere.
• Proven ability to work independently and drive results.
• Detail oriented, ability to multitask, proactive thinker.
• Experience with client implementations.
• Ability to research, analyze and resolve pharmacy benefit issues independently.
• Ability to take the lead on projects and see them through to completion.

Salary Range: 90,000 - 110,000