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Managed Care Analyst, Pharmacy Operations - Lakeland

Apply Job Req. ID 22071BR Date Posted 11/07/2022 Location Lakeland, Florida
  • perform in-depth and independent business analysis of Managed Care contracts and reimbursement, accounting for ~$5 billion dollars per year
  • compile and analyze data for contract reconciliation
  • establish and manage vendor relationships
  • design data tools and coding data to analyze, manage, and reconcile pharmacy pricing arrangements, evaluating appropriate pharmacy reimbursement levels (i.e. drug prices), and calculating the impact
  • represent the interests of Publix Pharmacy through NCPDP (National Council for Prescription Drug Programs).
Required Qualifications
  • Bachelor’s degree with concentration typically in Business, Actuarial Science, Mathematics, Finance, Statistics, Economics or related field, or equivalent work experience
  • at least 2 years of experience in a financial, analytic, or technical role
  • at least 2 years of experience with insurance billing practices, third party plans
  • at least 2 years of combined experience with any of the following: Access, Excel, Tableau, Python, R, Power BI, and/or database development
  • intermediate skills in actuary software tools: SQL, R, Python, Tableau and/or VBA
  • intermediate skills in Microsoft Word, Power Point, Outlook, Excel and Access
  • general healthcare industry knowledge related to: reimbursement methodologies, fee schedules, Healthcare Common Procedure Coding System (HCPCS) codes, edits, and claims adjudication practices for Medicare, Medicaid, Publix Pharmacy billing practices and standards, and Commercial payers, NCPDP codes and standards
  • knowledge of HIPAA, FWA, and CMS regulations as related to billing and credentialing requirements and regulatory compliance
  • knowledge of contract management, negotiation best practices, and implementation
  • critical thinking skills and broad financial knowledge
  • general knowledge of third party enrollment, billing, and third party auditing
  • knowledge of accounting terms and high financial acumen
  • knowledge of health insurance practices involving pharmacies
  • ability to multi-task and execute
  • ability to work proactively
  • analytical skills for independent problem solving
  • ability to work in an independent and self-directed manner with limited supervision and as a team player
  • professional communication skills and ability to communicate effectively in both written and verbal format
  • ability to learn and adapt quickly
  • ability to decipher and reconcile large data sets using actuary tools
  • high level of self-motivation and drive is required
  • willingness to work 45 hours minimum per week.
Preferred Qualifications
  • MBA or Master’s degree in a business or healthcare related field
  • 3+ years of experience with Access, Excel, Tableau, Python, R, Power BI, SQL, VBA and/or database development
  • 2+ years of experience with Medicare/Medicaid regulations, programs, and billing
  • 2+ years of experience with in depth analysis of third party claims, reimbursement, and third party pricing methodologies
  • at least 1 year of experience with contracts analysis, negotiation, and implementation.
  • experience with Enterprise Rx
  • Pharmacy Benefit Manager (PBM) experience
  • knowledge of 340B programs, processes, and fee structures
Potential Annual Pay with Bonus 59,020 - 88,855 Minimum Base Pay 4,540 Maximum Base Pay 6,835 Frequency of Pay Monthly Hours of Work Monday - Friday with varied schedule. Minimum 45 hours per week. Travel Frequency 0% Year End Bonus As a year-end bonus to associates, Publix issues one month’s extra pay (pro-rated in the first year) each year if associate remains employed through issue date of the bonus check that year. This is calculated as a 13th month of pay in the Potential Annual Pay with Bonus line above. Address 3300 Publix Corporate Parkway City Lakeland Region FL between Orlando and Tampa Potential Annual Base Pay 59,020 - 88,855 Benefits
  • Employee stock ownership plan that contributes Publix stock to associates each year at no cost
  • An opportunity to purchase additional shares of our privately-held stock
  • 401(k) retirement savings plan
  • Group health plan (with prescription benefits)
  • Group dental plan
  • Group vision plan
  • Sick pay
  • Paid Parental Leave
  • Long-term disability insurance
  • Company-paid life insurance (with accidental death & dismemberment benefits)
  • Tuition reimbursement
  • Vacation pay
  • Free hot lunches (buffet-style) at facilities with a cafeteria
  • Paycheck direct deposit
  • Credit union
  • Access to over 50 discount offers including discounts on computer, vehicle and wireless purchases
  • 6 paid holidays (associates can exchange the following holidays with their manager’s approval: New Year’s Day, Memorial Day, Fourth of July, and Labor Day)

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