RxSense is hiring a
Formulary Operations Analyst

Summary

Join RxSense as we empower clients and consumers with technology to access lower cost prescription drugs. As a Formulary Operations Specialist, you will be responsible for implementing, maintaining, and evaluating formularies for clients and pharmacies in RxIQ, the adjudication platform of RxSense.

Requirements

• Bachelor’s degree preferred or equivalent work experience
• Previous experience with formulary operations, pharmacy claims processing and familiarity with analytical methods is preferred
• Strong knowledge of PBM drug data management
• Advanced knowledge of Microsoft Office Suite to create complex documents and analyze data
• Experience as a user of multiple business software applications and advance working knowledge of key business applications and claims adjudication systems
• Strong business acumen, analytical skills, written and oral communication skills

Responsibilities

• Utilizes planning, prioritizing, and organizational skills to effectively manage formularies, tools, and processes necessary to achieve business objectives
• Analyzes claims adjudication results and identifies discrepancies, inaccuracies and anomalies
• Troubleshoots and mitigates reported claims defects
• Research clinical and claims related inquiries from RxSense clients and internal departments
• Maintains plan formularies in claims processing system and confirms coding changes have been completed and implemented accurately
• Execute formulary changes per client intent to ensure formularies will adjudicate at point-of-sale as expected
• Maintains, facilitates access to, and distributes member documents and websites
• Assists with implementations – gathering and documenting requirements and supporting formulary builds
• Completes special projects and assignments (such as documenting processes and procedures and facilitating with internal and external training
• Actively participates as a key member of cross functional workgroups, teams, and committees as assigned
• Ensures timely deliverables, high levels of quality, and efficient use of resources
• Maintains a knowledge base of RxSense standard offerings and services