Business Analytics Associate
CVSHealth
- Springfield, Missouri, United States
- Springfield, Missouri, United States
About
Position Summary The MAC team is responsible for all aspects of MAC list maintenance. This includes creating new MAC lists and managing existing MAC lists, uploading MAC prices to the adjudication platform and all MAC related QC processes. The MAC team works closely with the Finance Guarantee team to help ensure client commitments are met by making MAC adjustments as appropriate. The MAC team is also responsible for reviewing and responding to all pharmacy MAC appeals and working with the Legal team to respond to any MAC related complaints from state agencies. In addition, the MAC team monitors pharmacy GER guarantees and makes MAC adjustments as needed. The MAC team is also responsible for all MAC related reporting, including client and pharmacy reports.
Responsibilities
MAC Pricing Compliance & Inquiry Resolution : Review and resolve pharmacy inquiries related to Maximum Allowable Cost (MAC) pricing, ensuring compliance with MAC law requirements.
Data Validation & Source Verification : Validate pricing and product information using trusted sources such as Medispan, manufacturers, and wholesalers.
Database Management & Timely Communication : Accurately update the Pharmacy Inquiry Database and ensure timely responses to pharmacies within established turnaround times (TAT).
Market Monitoring & Issue Escalation : Identify changes in marketplace conditions and promptly elevate potential issues to minimize impact on pharmacies and plan members.
Team Support & Training : Assist a team of coordinators by answering questions and providing training support as needed.
IT Implementation Testing : Monitor and perform testing activities related to IT system implementations to ensure functionality and accuracy.
Regulatory Inquiry Support : Research and respond to Department of Insurance (DOI) inquiries, providing accurate and timely information to state regulators.
Ad Hoc Management Support : Provide assistance to management with various ad hoc tasks and special projects as assigned.
Required Qualifications
2–5 years of experience in Pharmacy benefit management (PBM)
Pharmaceutical pricing or reimbursement
Healthcare compliance or regulatory affairs
Data analysis or financial modeling
Education: Associate degree required
Anticipated Weekly Hours: 40
Time Type: Full time
Preferred Qualifications
Experience with RxClaim platform (AS 400)
SAS experience
Bachelor's Degree
Pay Range : $21.10 - $44.99 per hour. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. The full‑time position is eligible for a comprehensive benefits package that includes medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources based on eligibility.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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Languages
- English
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