Pharmacy Network Research and Performance Analyst

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.

Position Summary: 

The Pharmacy Network Research and Performance Analyst is responsible for creating, maintaining, monitoring, testing, and reporting on all data elements regarding pharmacy adjudication, leveraged by Operations for decision making. Key responsibilities, but are not limited to, the review of incumbent pharmacy claims data prospects and new client implementations. Daily functions require a strong working knowledge of the pharmacy claims processing ecosystem and applying industry standard data points. The Pharmacy Network Research and Performance Analyst is solely responsible for perceiving and effectively communicating the impact of changes or trends in real-time to leadership.

Essential Duties and Responsibilities: 

• Provide Monthly Network Performance Reports per Client detailing analysis optimizing/maximizing client-pharmacy utilization.
• Responsible for leveraging current BI Tools and for collaborating with Products Teams to engage and enhance Adjudication and BI Platforms
• Generates quarterly updates of pharmacy network offerings, as well as the summarization of gap analyses, audit findings, member impact, and similar client-based impact reports.
• Actively engage client implementations for necessary updates regarding ongoing work not limited to network disruption analysis, sales up-sell, and new client
• Creates and populates audit analysis spreadsheets and databases.
• Produces analysis of pharmacy networks based on service area, measuring potential member disruption based on changes to the network, such as pharmacy closures.
• Produces reports for payment variances and/or rejected/denied/reduced claims.
• Develops and updates Standard Operating Procedures (SOPs) for data use and analysis.
• Collaborates with key stakeholders to support pharmacy growth initiatives.
• Provides oversight of claim monitoring processes, focusing on improving the intraday monitoring of adjudication
• Establish and maintain relationships with implementations, client services, benefit administrations, ,UAT/QA, IT, finance, clinical staff with focus on actively engaging the appropriate teams to accurately implement new clients
• Various ad hoc requests, as requested.
• Assist the Director and staff with process and development projects.
• Other duties as assigned.

Required Qualifications:  

• Intermediate to Expert-Level Excel-based data processing to report optimal client solutions.
• Proficient knowledge and ability to leverage SQL to report directly from database.

• 2+ years of experience in a retail pharmacy setting and/or pharmacy benefits management organization.
  • Strong understanding of the pharmacy claims processing ecosystem
  • Strong understanding of pharmacy relationships and NCPDP data extracts
• Strong understanding of GeoAccess and market penetration reports; leveraging CMS Guidelines
• Ability to research, analyze and report on pharmacy relationships and claims processing trends.
• Ability to analyze current client builds and present optimal solutions in future state using change in market and contract prioritization.
• Proven ability to work independently and drive results.
• Detail-oriented, ability to multitask, proactive thinker.
• Exceptional communication skills

Salary Range: $71,000 - $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 proc