Pharmacy Network Compliance Analyst

NHSHP; Concord (NH); Hybrid; USD 44,000 - 102,000; Full time

Job summary

CVS Health is seeking an Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex pharmacy contract non-compliance issues. This role requires meticulous attention to detail and the ability to manage multiple priorities while coordinating with cross-functional teams.

The position emphasizes outreach to network pharmacies, evaluation of non-compliance concerns, and adherence to contractual and regulatory requirements.

Qualifications

• 3+ years of retail pharmacy experience.
• 2+ years of claims adjudication research experience.
• 2+ years of experience with Microsoft Office applications (Excel, Outlook, Word).
• Bachelor's degree required.

Responsibilities

• Investigate and resolve pharmacy contract non-compliance allegations, including complex and sensitive cases.
• Conduct outreach to pharmacies to gather information and address identified issues.
• Analyze claims data and adjudication results to support findings and recommendations.
• Partner with Sales, Account Management, and other internal teams to coordinate resolution efforts.
• Prepare detailed written responses for plan sponsors, participants, and internal stakeholders.
• Address and resolve customer concerns related to network pharmacy performance.
• Maintain thorough documentation of investigations and outcomes.
• Manage multiple cases simultaneously while meeting deadlines and maintaining accuracy.

Skills

Retail pharmacy experience

Claims adjudication research

Microsoft Office (Excel, Outlook, Word

Education

Bachelor's degree

Tools

PBM software

Claims adjudication software

Job description

CVS Health is seeking an Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex pharmacy contract non-compliance issues. This role requires meticulous attention to detail and the ability to manage multiple priorities while coordinating with cross-functional teams.

The position emphasizes outreach to network pharmacies, evaluation of non-compliance concerns, and adherence to contractual and regulatory requirements.