Pharmacy Cost Containment Analyst

MCS Puerto Rico; San Juan (PR); On-site; USD 65,000 - 90,000; Full time

Job summary

MCS Puerto Rico in San Juan, PR is seeking an experienced analyst to analyze claims and payment data to ensure payment integrity and cost containment within the unit. The role supports management by preparing reports and converting regulatory data into information for decision-making and business objectives.

Regular, exempt position requiring advanced Excel and Power BI skills, with focus on pharmacy cost management and compliance with relevant regulations and programs.

Qualifications

• Bachelor’s degree in a relevant field with at least 3 years in healthcare analytics or finance.
• Strong data analysis skills and attention to detail.
• Advanced Excel and working knowledge of Power BI and data reconciliation.

Responsibilities

• Analyze pharmacy cost management processes related to Inflation Reduction Act provisions.
• Implement and modify cost management processes affected by the Act.
• Reconcile and validate underlying pharmacy data and utilization reports.
• Develop data extracts to identify weaknesses and opportunities in cost management.
• Monitor trends and communicate regulatory changes affecting cost management.
• Coordinate reporting packages for RxDC and MCAS as needed.
• Prepare low-complexity data extraction reports and summaries.

Skills

Pharmacy cost management

Data analysis

Excel

Power BI

Regulatory compliance

Education

Bachelor’s Degree in Business Administration

Healthcare Administration

Tools

Power BI

Excel

SQL

Data reconciliation tools

Job description

GENERAL DESCRIPTION

Analyze claims and payment data to ensure payment integrity and cost containment within the unit. Responsible for preparing reports and converting the regulatory data into useful and actionable information to support management in decision-making and achieve the company's business objectives.

Regular

Exempt

ESSENTIAL FUNCTIONS

• Analyze pharmacy cost management processes of provisions related to the Inflation Reduction Act, such as the Medicare Prescription Payment Plan, Part D Redesign Model, Manufacturer Discount Program, and Medicare Drug Price Negotiation Program, among others.
• Implement, coordinate, and modify pharmacy cost management processes affected by provisions from the Inflation Reduction Act, among others.
• Reconcile and validate underlying pharmacy analytic data claims, and utilization management within the unit and interpret and analyze utilization reports that reflect financial impact trends to support management in decision-making and provide recommendations.
• Participate in improvement initiatives and develop data extracts needed to identify weaknesses and opportunities that will enhance the pharmacy cost management process.
• Identify anomalous utilization patterns, investigate cost containment, and test pharmacy claims alignment with vendors contracted rates in the system for the accuracy of configurations accordingly with business requirements and compliance standards.
• Monitor, analyze trends, interpret, and communicate regulatory changes that affect the Pharmacy cost management process.
• Administer the pharmacy claims and invoices related to provisions from the Manufacturer Discount Program, Medicare Drug Price Negotiation Program, and Medicare Prescription Payment Plan, among others.
• Coordinate and validate the Prescription Drug Data Collection (RxDC) and Market Conduct Annual Statement (MCAS) reporting packages.
• Develop reports on requests with low complexity, such as data extraction reports and summaries.
• Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
• May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.

MINIMUM QUALIFICATIONS

Education and Experience

Bachelor’s Degree in Business Administration, Statistics, Healthcare Administration, Natural Sciences, Finance, Accounting, Information Systems, or a related field. At least three (3) years of experience in similar functions in any of the following areas: pharmacy practice, healthcare administration, finance, data management and analysis, preferably within the Healthcare Industry. Experience with business process analysis and reporting and/or managing Medicare products and capabilities is preferred.

"Proven experience may be replaced by previously established requirements."

Certifications / Licenses

Not required.

Other

Advanced knowledge of Microsoft Excel is required. Intermediate knowledge of Power BI is preferred. Knowledge in analyzing and managing tables and data. Knowledge of pharmacy claims processing platforms and clinical programs, as well as pharmacy operations and reporting requirements. Knowledge of database systems and data reconciliation processes.

Languages

• Spanish - Advanced (comprehensive, writing and verbal)
• English - Intermediate (comprehensive, writing and verbal)

"We are an Equal Employment Opportunity Employer and take affirmative action to recruit protected veterans and individuals with disabilities."