Plan Analyst

BrightSpring Health Services; Louisville (KY); On-site; USD 65,000 - 90,000; Full time

Job summary

PharMerica, an affiliate of BrightSpring Health Services, is seeking a Plan Analyst to establish and manage pricing and plan parameters in pharmacy practice systems to support client contracts and 3rd party plans.

The role involves pricing implementation, researching client pricing and coverage setup, and ensuring accurate claim processing across LTC400 and RxExact platforms. Collaboration with internal partners and participation in special projects are expected.

Qualifications

• Bachelor’s degree required.
• 3+ years corporate experience.
• Experience with Long Term Care, Pharmacy Practice Management Systems, Healthcare Billing, Retail Pharmacy Tech, Insurance and/or PBM preferred.
• Ability to work with a high degree of accuracy and attention to detail.
• Strong interpersonal skills to work effectively with internal customers and Microsoft Office products.
• Knowledge of claims processing system or pharmacy practice system desired.
• Strong analytical and critical thinking skills.
• Advanced Excel and/or data knowledge.

Responsibilities

• Maintains client pricing and pharmacy coverage parameters in the pharmacy practice systems.
• Conducts research and provide information to internal partners on client pricing and coverage set-up.
• Ensures accurate claim processing by correcting and communicating discrepancies found in set-up and/or quality assurance testing and recommends appropriate plan set-up changes and/or system modifications when required.
• Analyzes the client request and determine the best operational approach and perform set-up.
• Conducts research and provide information to internal partners on client pricing, coverage set up and product file questions.
• Provides consultation and expertise to internal partners.
• Participates and/or takes the lead in special projects.
• Performs other tasks as assigned.
• Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards

Skills

Analytical thinking

Attention to detail

Microsoft Office

Excel

Communication skills

Education

Bachelor’s degree

Tools

LTC400

RxExact

Job description

Our Company

PharMerica

Overview

The Plan Analyst establishes and sets up pricing and plan parameters in the pharmacy practice systems to support PharMerica client contracts and 3rd party plans. Responsible for the client pricing implementation process and pricing changes, resolving client issues, working in LTC400 and RxExact pharmacy systems for standard and complex plan designs. May work with formularies, the product file, and/or IV setups.

Responsibilities

• Maintains client pricing and pharmacy coverage parameters in the pharmacy practice systems
• Conducts research and provide information to internal partners on client pricing and coverage set-up
• Ensures accurate claim processing by correcting and communicating discrepancies found in set-up and/or quality assurance testing and recommends appropriate plan set-up changes and/or system modifications when required
• Analyzes the client request and determine the best operational approach and perform set-up
• Conducts research and provide information to internal partners on client pricing, coverage set up and product file questions
• Provides consultation and expertise to internal partners
• Participates and/or takes the lead in special projects
• Performs other tasks as assigned
• Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required. Each essential function is required, although reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Qualifications

• Bachelor’s degree
• Three or more years corporate experience
• Long Term Care, Pharmacy Practice Management System setup, Healthcare Billing, Retail Pharmacy Tech, Insurance and/or PBM experience preferred
• Ability to work with a high degree of accuracy and attention to detail
• Strong interpersonal skills to work effectively with internal customers Microsoft office products
• Knowledge of claims processing system or pharmacy practice system desired
• Strong analytical and critical thinking skills
• Advanced Excel and/or data knowledge

About our Line of Business

PharMerica, an affiliate of BrightSpring Health Services, delivers personalized pharmacy care through dedicated local teams, serving health care providers such as skilled nursing facilities, senior living communities, and hospitals. We also cater to individuals with behavioral needs, infusion therapy needs, seniors receiving in-home care, and patients with cancer. Operating long-term care, home infusion, and specialty pharmacies across the nation, we combine the personal touch of a neighborhood pharmacy with the resources of a national network. Our comprehensive solutions, backed by industry-leading technology and regulatory expertise, ensure accurate medication access, cost control, and compliance with best-in-class clinical standards. We are committed to enhancing resident health, reducing staff burdens, and supporting our clients' success. For more information, visit www.pharmerica.com. Follow us on Facebook, Twitter, and LinkedIn.