Pharmacy Network Compliance Analyst

Hispanic Alliance for Career Enhancement; Little Rock (AR); On-site; USD 43,888 - 102,081; Full time

Benefits offered by this job

Great benefits

Health, dental, vision

Job summary

CVS Health is seeking an Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex contract non-compliance issues within the pharmacy network. The role requires meticulous analysis, cross-functional collaboration, and timely resolution of cases.

You will engage with network pharmacies, review claims data, and prepare clear written responses for plan sponsors and internal stakeholders, while maintaining thorough documentation and meeting deadlines in a fast-paced environment.

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

MS Office (Excel, Outlook, Word)

Education

Bachelor's degree

Job description

CVS Health is seeking an Analyst - Pharmacy Network Non-Compliance to investigate and resolve complex contract non-compliance issues within the pharmacy network. The role requires meticulous analysis, cross-functional collaboration, and timely resolution of cases.

You will engage with network pharmacies, review claims data, and prepare clear written responses for plan sponsors and internal stakeholders, while maintaining thorough documentation and meeting deadlines in a fast-paced environment.