Job Description
Specific job functions include:
Review and understand PBM contracts for all relevant pricing terms
Review and understand plan design documents provided by PBM or client
Utilize company's proprietary Compliance Model
Calculate client contractual financial guarantees, admin fees, rebates and other terms as required by client contract
Assemble audit reports and summarize findings
Document all potential issues and track decisions
Collaborate with account management and pharmacy consultants to discuss results with clients and vendors
Provide documentation during follow-up negotiations and discussions
Work with IT to further develop Compliance Model logic and capabilities
Assist in other financial projects as needed
Requirements:
Bachelor's degree in Business, Finance, or other health related field
At least 3 years of either a) pharmacy benefit audit or b) claim adjudication research experience on one or more PBM platforms
Working knowledge of the PBM industry and pharmacy benefit claims
Desired Skills:
Proficient in Microsoft Office, with extensive experience working with Excel
Basic SQL query building
Strong verbal and written communication skills
Detail-oriented
Solid, independent worker (this position will likely be based in the applicant's home)
Pharmacy Technician Certification (preferred)
Company DescriptionLeading specialty benefits management company in Puerto Rico and South Florida. Our innovative care management model integrates the needs of providers, payors and members to ensure the delivery of high quality, cost effective care while realizing substantial millions of dollars savings that keep the cost of healthcare down.
We are building a model for managing care delivery that embodies traditional values, promises reliability, and embraces flexibility and technology. Through our experience in the healthcare industry, the company aims to improve healthcare outcomes, achieve cost savings and serve as a single point of contact to move into value-based care.
Company Description Leading specialty benefits management company in Puerto Rico and South Florida. Our innovative care management model integrates the needs of providers, payors and members to ensure the delivery of high quality, cost effective care while realizing substantial millions of dollars savings that keep the cost of healthcare down. We are building a model for managing care delivery that embodies traditional values, promises reliability, and embraces flexibility and technology. Through our experience in the healthcare industry, the company aims to improve healthcare outcomes, achieve cost savings and serve as a single point of contact to move into value-based care.