Job Description

The Pharmacy Network Pricing Analyst is responsible for reimbursement price modeling and Maximum Allowable Cost (MAC) pricing strategy. This role involves analyzing, modeling, and administering pharmacy reimbursement rates to maintain competitiveness, maximize profitability, and ensure contractual compliance, utilizing tools like Snowflake/SQL and understanding pharmacy claims data.

Responsibilities

• Develop and maintain MAC models
• Execute and optimize network and pricing innovations
• Ensure pricing strategies adhere to contracts
• Provide assistance to the Pharmacy Network team
• Run weekly automated pricing tasks
• Collaborate with legal on MAC appeals and compliance
• Perform pharmacy analytics reporting and modeling
• Develop and distribute reports
• Support the pharmacy pricing appeals process
• Create automation around core business processes

Requirements

• Bachelor’s Degree or 3-5 years of relevant experience in PBM, health plan, or pharmacy industry
• Strong analytical, statistical, or economic acumen
• Strong analytical, detail-oriented, and problem-solving skills
• Ability to manage multiple tasks simultaneously
• Demonstrated problem-solving skills
• Strong background in financial reporting and data management
• Expert proficiency in SQL
• Experience with large claims datasets
• Proficiency in Looker

Benefits

• No benefits