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Pharmacy Benefit Compliance Analyst

2 months ago

Miami, Florida, United States Secure Eclaims LLC Full time
Job Overview

We are seeking a dedicated Pharmacy Benefit Compliance Analyst to join our team. This role is essential in ensuring adherence to pharmacy benefit management standards and contractual obligations.

Key Responsibilities:

Primary duties include:

  • Analyzing and interpreting PBM contracts to identify relevant pricing provisions.
  • Reviewing plan design documents from PBM or clients to ensure compliance.
  • Employing the proprietary Compliance Model developed by the company.
  • Calculating financial guarantees, administrative fees, rebates, and other terms as specified in client contracts.
  • Compiling audit reports and presenting findings in a clear and concise manner.
  • Documenting potential issues and tracking decision-making processes.
  • Collaborating with account management and pharmacy consultants to communicate results effectively with clients and vendors.
  • Providing necessary documentation during follow-up negotiations and discussions.
  • Working alongside IT to enhance the Compliance Model's logic and capabilities.
  • Assisting with additional financial projects as required.
Qualifications:

Required:

  • Bachelor's degree in Business, Finance, or a related health field.
  • A minimum of 3 years of experience in pharmacy benefit auditing or claims adjudication research on PBM platforms.
  • Strong understanding of the PBM industry and pharmacy benefit claims.

Preferred Skills:

  • Proficiency in Microsoft Office, particularly Excel.
  • Basic skills in SQL query building.
  • Excellent verbal and written communication abilities.
  • Detail-oriented with a strong focus on accuracy.
  • Ability to work independently, as this position may be remote.
  • Pharmacy Technician Certification is a plus.
Company Overview

Secure Eclaims LLC is a leading specialty benefits management organization dedicated to enhancing healthcare delivery in Puerto Rico and South Florida. Our innovative care management model aligns the interests of providers, payors, and members, ensuring the provision of high-quality, cost-effective care while achieving significant savings in healthcare costs.

We are committed to developing a care delivery model that reflects traditional values, ensures reliability, and embraces both flexibility and technology. Through our extensive experience in the healthcare sector, we aim to improve healthcare outcomes, realize cost efficiencies, and serve as a comprehensive resource for transitioning to value-based care.