Senior Managed Care Consultant – Pharmacy

Location: Lakeland, FL between Orlando and Tampa
Job ID: 25595BR
Department: Pharmacy Operations
Date Posted: Aug 11, 2023

$70 - 107k

Onsite

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Description

If you want to solve exciting and cutting-edge analytics problems related to the healthcare industry, and also enjoy the stability of a Fortune 100 company, then the Publix Managed Care team may be right for you. We are a dynamic team responsible for optimizing profitability and reimbursement for Publix Pharmacy and the Senior Managed Care Consultant serves as the subject-matter expert in contract analysis and reporting. The Senior Managed Care Consultant is instrumental in the design, development, and maintenance of analytical tools and systems used to conduct financial contract analysis for Managed Care and the Pharmacy Retail Business Unit (RBU). This role will train and guide other managed care support members in the analysis of large data sets using pharmacy data and will also develop processes and procedures for routine and non-routine contract and reimbursement analysis to assist in solving complex business problems.

Description:

• Perform in-depth and independent financial analysis of Managed Care contracts and reimbursement
• Compile and analyze data for contract reconciliation
• Establish and manage vendor relationships
• Design and manage data tools and processes to analyze and reconcile pharmacy pricing arrangements and evaluate pharmacy reimbursement (i.e., prescription sales), and calculating the impact of deviations from contracted rates

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Required Qualifications

• Bachelor’s degree in Analytics, MIS, Information Technology, Computer Science, Statistics, Engineering, Actuarial Sciences, Economics, Mathematics, or another analytical discipline from an accredited college or university or its equivalent
• Demonstrated experience solving analytical problems (work experience or course work)
• At least 2 years of experience in a financial, analytic, or technical role
• At least 2 years of experience with insurance billing practices, third party plans
• At least 2 years of combined experience with any of the following: Access, Excel, Tableau, Python, R, Power BI, and/or database development
• Intermediate skills in actuary software tools: SQL, R, Python, Tableau and/or VBA
• Intermediate skills in Microsoft Word, Power Point, Outlook, Excel, and Access
• General healthcare industry knowledge related to reimbursement methodologies, fee schedules, Healthcare Common Procedure Coding System (HCPCS) codes, edits, and claims adjudication practices for Medicare, Medicaid, Publix Pharmacy billing practices and standards, and Commercial payers, NCPDP codes and standards
• Knowledge of HIPAA, FWA, and CMS regulations as related to billing and credentialing requirements and regulatory compliance
• Critical thinking skills and broad financial knowledge
• General knowledge of third-party enrollment, billing, and third-party auditing
• Knowledge of accounting terms and high financial acumen
• Knowledge of health insurance practices involving pharmacies
• Ability to multi-task and execute
• Ability to work proactively
• Analytical skills for independent problem solving
• Ability to work in an independent and self-directed manner with limited supervision and as a team player
• Professional communication skills and ability to communicate effectively in both written and verbal format
• Ability to learn and adapt quickly
• Ability to decipher and reconcile large data sets using actuary tools
• High level of self-motivation and drive is required
• Willingness to work 45 hours minimum per week

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Preferred Qualifications

• MBA or Master’s degree in Data Analytics, Computer Science, Information Systems, or equivalent
• 3+ years of experience with Access, Excel, Tableau, Python, R, Power BI, SQL, VBA and/or database development
• 2+ years of experience with Medicare/Medicaid regulations, programs, and billing
• 2+ years of experience with in-depth analysis of third-party claims, reimbursement, and third-party pricing methodologies
• At least 1 year of experience with contract analysis, negotiation, and implementation
• Experience with Enterprise Rx
• Pharmacy Benefit Manager (PBM) experience
• Recent completed analytics courses from LinkedIn Learning, Coursera or similar

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Benefits

• Employee stock ownership plan that contributes Publix stock to associates each year at no cost
• An opportunity to purchase additional shares of our privately-held stock
• 401(k) retirement savings plan
• Group health plan (with prescription benefits)
• Group dental plan
• Group vision plan
• Sick pay
• Paid Parental Leave
• Long-term disability insurance
• Company-paid life insurance (with accidental death & dismemberment benefits)
• Tuition reimbursement
• Vacation pay
• Free hot lunches (buffet-style) at facilities with a cafeteria
• Paycheck direct deposit
• Credit union
• Access to over 50 discount offers including discounts on computer, vehicle and wireless purchases
• 6 paid holidays (associates can exchange the following holidays with their manager’s approval: New Year’s Day, Memorial Day, Fourth of July, and Labor Day)

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Additional Information

Your application may have additional steps that you will need to complete in order to remain eligible for consideration. Please be sure to monitor your email, including your spam folder, on a daily basis for critical, time-sensitive emails that could require action within 24-48 hours.

Please do not use your Publix email address when applying. Once your application has been successfully submitted you will receive a confirmation email.

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