Network Pricing Data Analyst

About Capital Rx 

Capital Rx is a health technology company providing claim administration and technology solutions for carriers, health plans, TPAs, employer groups, and government entities. As a public benefit corporation, Capital Rx is executing its mission to materially reduce healthcare costs as a full-service PBM and through the deployment of Judi®, the company’s cloud-native enterprise health platform. Judi connects every aspect of the healthcare ecosystem in one efficient, scalable platform, servicing millions of members for Medicare, Medicaid, and commercial plans. Together with its clients, Capital Rx is reimagining the administration of benefits and rebuilding trust in healthcare.

Location: Remote (For Non-Local) or Hybrid (Local to NYC area)

Position Summary:

As a member of the Enterprise Solutions team, you will pay a critical role in contributing to the success of Capital Rx’s customers leveraging Judi, our Enterprise Health Platform, to service their own pharmacy administrative needs. The enterprise solution team seeks individuals who are passionate to change the landscape of claims processing while providing superior service. The Network Pricing Analyst supports the configuration, validation, and reporting of pharmacy network data within Capital Rx’s Judi® platform.  Strong data skills, experience handling large volume claims data, and the ability to manage multiple priorities are essential.

Position Responsibilities:

• Accountable for accurate translation of network data and reporting requirements of Capital Rx’s Software as a Service (SaaS) customers for migration and ongoing use of JUDI.
• Support all network analytics needs of internal team members and customers.
• Execute and support existing processes such as, but not limited to:
• Assist with intake and conversion of files necessary for parallel Network Validation data review.
• Develop Network testing automation.
• Support Network and Provider Agreement data reporting, claims analysis, or other network pricing related reporting
• Develop and maintain data reporting repositories as it relates to all facets within the network setup.
• Perform QA and claims testing to validate that network data loads yield appropriate adjudication results.
• Support testing for new JUDI functionality to ensure new enhancements are functioning as expected and accurately processing claims transactions.
• Reconcile adjudication output variances with support from network subject matter experts, and maintain data lineage for network configuration data.
• Provide customers facing subject matter expertise support on JUDI’s network reporting capabilities.
• Contribute to playbooks/templates that scale network configurations for future client onboardings.
• Take charge of critical issues or problems to key stakeholders, ensuring swift resolution and communication within service level agreements.
• Partner with Analytics colleagues to author automated/manual test cases and monitoring processes for drug coverage configurations and data loads.
• Monitor performance metrics (load times, claims accuracy discrepancies) and recommend optimizations.
• Certain times of year may require meeting participation, travel, service support or other requirements outside of standard business hours, including weekends.Responsible for adherence to the Capital Rx Code of Conduct, including reporting of noncompliance.

Minimum Qualifications:

• 1+ years of experience in an Analyst role, Software Engineering role or related work experience
• 1+ year of PBM or Health Plan operations experience with pharmacy claims data and reimbursement methodologies.
• Experience performing complex analyses on large sets of data
• Experience working with structured and unstructured data
• Proficient in SQL, JSON, Java, R, Excel, and other data visualization tools
• Track record of leading cross-functional initiatives, driving high performance, meeting deadlines, and executing on deliverables.
• Exceptional project / time management, prioritization, and organizational skills to ensure customer satisfaction.
• Ability to shift between competing priorities and meet organizational goals.
• Excellent verbal, written, interpersonal and presentation skills.
• Ability to work effectively with virtual teams.
• Ability to travel 5-10%.

Preferred Qualifications:

• Bachelor's Degree preferred, or equivalent combination of education, training, and experience.
• Experience working with AWS Redshift
• Pharmacy Benefit Management analytics preferred

Salary Range$80,000