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 Formulary Operations Analyst in the Enterprise Platform Services division will be the subject matter expert for RxSense’s standard formulary offerings and clinical programs. This role supports client implementations and formulary drug maintenance. The Formulary Operations Analyst will have an excellent working knowledge of RxSense products and processes and establish day to day relationships with cross functional areas. The role will require active engagement and involvement in client interactions including leading training sessions and serving as a bridge between the technology platform and clinical objectives. The Formulary Operations Analyst will report to the VP of Clinical Services and support clinical pharmacists.
Essential Duties and Responsibilities:
- Develop a high degree of knowledge about pharmacy claims and RxSense claims platforms.
- Analyzes claims adjudication results and identifies discrepancies, inaccuracies and anomalies.
- Troubleshoots and mitigates reported claims defects.
- Researches clinical and claims related inquiries from RxSense clients and internal departments.
- Maintains plan formularies in claims processing system and confirms coding changes have been completed and implemented accurately.
- Executes formulary changes per client intent to ensure formularies will adjudicate at point-of-sale as expected.
- Maintains, facilitates access to, and distributes clinical member documents and websites.
- Assists with implementations – gathering and documenting requirements and supporting formulary builds.
- Completes special projects and assignments (such as documenting processes and procedures and formulary disruptions analyses).
- Actively participates as a key member of cross functional workgroups, teams, and committees as assigned.
- Ensures timely deliverables, high levels of quality, and efficient use of resources.
- Build solid working relationships both internally and externally with clients.
- Communicate system enhancement requests effectively to development teams.
Education and Experience:
- Bachelor’s degree or 5 + years equivalent experience in healthcare (PBM).
- Experience with pharmacy technology and claims processing.
- Strong Experience with Microsoft Suite.
- Must be able to develop and maintain strong working relationships on a multi-level basis.
- Superior written and verbal communication skills - ability to communicate information & ideas clearly & concisely both internal and external (client facing).
- Excellent organizational & time management skills.
- Ability to work in a dynamic fast paced atmosphere.
- Proven ability to work independently and drive results.
- Detail oriented, ability to multitask, proactive thinker.
- Experience with client implementations.
- Ability to research, analyze and resolve pharmacy benefit issues independently.
- Ability to take the lead on projects and see them through to completion.
Salary Range: 90,000 - 110,000
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 process is free from discriminatory hiring practices and all qualified applicants are considered for employment without regard to race, color, religion, sex, gender, sexual orientation, gender identity, ancestry, age, or national origin. Neither will qualified applicants be discriminated against on the basis of disability or protected veteran status. We believe in the strength of the collaboration, creativity and sense of community a diverse workforce brings.
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What We Do
RxSense (www.rxsense.com) is a high growth and mission-driven healthcare technology company that provides sophisticated cloud-based enterprise solutions for flexible, efficient, and transparent pharmacy benefits administration, claims processing and advanced analytics serving pharmacy benefit managers, health plans, health systems, as well as new and non-traditional industry entrants. RxSense also utilizes its advanced platform and direct contracts with the nation's largest pharmacies (including CVS, Walmart and Walgreens) to deliver consistently low prices direct to consumers on prescription drugs through its SingleCare (www.singlecare.com)prescription savings services. RxSense's mission is to deliver industry leading technology solutions that improve healthcare transparency and access to more affordable medications for millions across America.
