Meridian

  • Formulary Analyst

    Job Location US-MI-Detroit
    Job ID
    2018-5514
    Category
    Pharmacy
    Business Line
    MRx
  • Overview

    Who we are:

    MeridianRx is a full-service Pharmacy Benefit Manager (PBM) committed to driving down costs and elevating quality. Our clients experience better quality outcomes, thanks to effective clinical support, patient education, and specialty pharmacy programs.


    We work with a diverse range of clients, from members to healthcare providers to plan administrators. MeridianRx services clients across the country and our network continues to grow.


    Our employees work hard, play hard, and give back. MeridianRx employees enjoy: Happy hours, special events, company sports teams, potlucks, Bagel Fridays, and volunteer opportunities.

     

    A Day in the Life of a Formulary Analyst:

    The Formulary Analyst works under the direction of the Department Director and/or Manager.  The Formulary Analyst provides both operational support to, and analysis of, all activities related directly and indirectly to Pharmacy Benefit Manager (“”PBM”) Formulary Management. In addition, the Formulary Analyst is responsible for acquiring and maintaining Subject Matter Expert (“SME”) knowledge of all formulary processes, rules and regulations. Further, the Formulary Analyst maintains responsibility for compiling and responding to all formulary-monitoring activities conducted by state, federal and other internal/external PBM Stakeholders, including (but not limited to) the preparation and submission of formulary-audit responses/data-collection initiatives and reporting.     

    Responsibilities

    • Interpret Medicare Part D, State Medicaid, Commercial and other applicable guidance surrounding regulatory/operational compliance with MeridianRx-Formulary Operations
    • Develop new and maintain existing Formulary Management Policies & Procedures (“P&P’s”)
    • Oversee and monitor all Formulary processes and procedures under MeridianRx’s purview, including but not limited to, Formulary File (“FF”) creation, Formulary PDF creation and Formulary logic/rule maintenance in the PBM System (MeridianRx Live Integrated Network (“MERLIN”)
    • Educate CMC employees regarding requirements set forth in MeridianRx Formulary P&Ps
    • Remain knowledgeable as to all applicable state and federal policy, regulations and guidance – including changes/updates to any of the aforementioned texts  
    • Integrate with the MeridianRx Quality Department to achieve improved HEDIS, CAHPS, Star Rating and HOS scores (as well as other applicable areas measured by any/all internal and external stakeholders)
    • Develop quarterly rebate estimates for accounting and reconciliation purposes
    • Analyzes disputed data and negotiate with drug manufacturers to fairly and accurately resolve disputes
    • Resolves unit disputes within six (6) months of receiving the drug manufacturer’s payment
    • Contacts pharmacy and medical providers in order to verify products dispensed to recipients as needed for dispute resolution
    • Contacts labelers for detailed information regarding disputed items and provide claim level within one week of request
    • Researches disputed pharmaceutical products in order to accurately prepare rebate resolution proposals
    • Completes and reconciles any/all required reporting pursuant to state, federal and/or commercial needs
    • Performs quality assurance and other testing as necessary with regard to all operational formulary implementations, including changes to existing system logic and/or previously implemented formularies
    • Review Prior Authorization, Step Therapy, Quantity Limit, and other formulary-related utilization management tools and processes
    • Identify and assist with the implementation of industry “Best Practices”

    Qualifications

    What you can bring to MeridianRx:

    • High school diploma is required.
    • Pursuit of Associate’s degree, Bachelor’s degree or Fellow designation from the Academy for Healthcare Management (AHM) is preferred.
    • Customer service experience or related health care industry experience is required
    • Experience with Meridian Health Plan’s (MHP’s) Managed Care System (“MCS”) and MeridianRx’s MeridianRx Live Integrated Network (“MERLIN”) System are required.
    • Demonstrated adaptability and flexibility to changes and response to new ideas and approaches is required.
    • Knowledge of managed care and the Medicaid and Medicare programs is required
    • Knowledge of the health plan programs, benefits, and services for all lines of business is required
    • Knowledge of National Committee for Quality Assurance (NCQA), URAC or general accreditation standards is preferred
    • Knowledge of appeal and grievance guidelines is preferred
    • Superior analytical and problem solving skills are required
    • Ability to think critically, identify issues with current processes and propose solutions to identified issues is required

    What MeridianRx can offer you:

    • Healthcare benefits that include a variety of plans, which are effective on the first day of employment for our new full-time team members. 
    • Opportunity to work with the industry’s leading technologies and participate in unique projects, demonstrations, conferences, and exclusive learning opportunities.
    • 401k matching that is above the national average. 
    • Full-time MeridianRx employees are eligible for tuition reimbursement towards Bachelor’s or graduate degrees.
    • A bright and engaging company culture; the Meridian family of companies has been recognized as one of Metro Detroit’s Best and Brightest Companies to Work For 5 years in a row. 

     

    Equal Opportunity Employer

     

    #MSTR

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