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Formulary Operations Analyst
Location
United States
Posted
2 days ago
Salary
$75K - $85K / year
Seniority
Junior
Job Description
Formulary Operations Analyst
RxSense
• Configure, update, and maintain custom and standard formularies within the claims adjudication system. • Ensure accuracy and alignment of formulary builds with client intent, clinical strategy, and regulatory requirements. • Troubleshoot adjudication issues and discrepancies; conduct detailed analysis to resolve defects and anomalies. • Participate in client implementations by gathering and documenting formulary requirements. • Serve as a clinical capabilities subject matter expert. • Collaborate with internal teams to ensure smooth integration of formulary solutions. • Perform audits to validate formulary configuration accuracy. • Monitor claim processing to detect and correct potential issues proactively. • Assist in analyzing and presenting data related to formulary performance or disruptions. • Pull, organize, and aggregate data and reports to support client meetings and formulary strategy presentations. • Support client interactions as needed, including responding to formulary-related inquiries and assisting in training sessions. • Work closely with clinical partners to ensure translation of clinical direction into accurate system configuration. • Contribute to development and documentation of internal workflows, best practices, and training materials. • Lead or contribute to special initiatives such as process optimization, disruption analyses, or platform enhancements. • Recommend and implement improvements to ensure greater accuracy, efficiency, and scalability of formulary operations.
Job Requirements
- Bachelor’s degree or 1 year equivalent experience in healthcare (PBM)
- 1+ year's of experience in formulary operations, pharmacy claims adjudication, or related healthcare analytics.
- Demonstrated expertise in configuring and maintaining formulary data within claims systems.
- Excellent working knowledge of formulary structures, Medispan/FDB data, and pharmacy benefit operations.
- Strong problem-solving skills with the ability to analyze data and translate findings into actionable solutions.
- Detail-oriented, with the ability to manage multiple priorities and meet deadlines.
- Superior written and verbal communication skills — clear and concise with both internal and client-facing audiences.
- Excellent organizational and time management skills.
- Ability to take the lead on projects and follow through to completion.
- Proficiency in Microsoft Excel and advanced knowledge of Microsoft Office Suite to create complex documents and analyze data.
- Self-starter with a proactive mindset and a high level of accountability.
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