SUMMARY

Department: Network Management
Reports To: Director of Network Pricing & Process Development
Supervises: N/A
FLSA Status: Exempt; Administrative

QUALIFICATIONS

Education: Bachelor’s Degree
Experience:

• 2 Year Experience in PBM/Healthcare and/or Analytics
• Financial Modeling & Reporting
• Data Management
• Reporting

KNOWLEDGE, SKILLS, AND ABILITIES

Candidate must possess the following:

• Strong analytical, detail oriented and problem solving skills. Ability to organize and manage multiple priority tasks simultaneously
• Problem solving ability in unstructured situations. Ability to effectively participate in meetings, accomplish goals and meet timelines. Ability to work well in cross-functional situations, giving clear direction and partnering with other internal departments to reach common goals
• Ability to self-motivate and self-manage daily tasks as this role will be offering remote work
• Ability to think creativity and challenge the status quo with particular emphasis on developing processes that are both accurate and efficient
• Mathematical, statistical, computer science, or economic acumen to assist in overall financial brand and generic pricing management
• Proficient user and/or understanding of query languages and/or Business Intelligence platforms that assist in day to day automation and procedures. Examples may include Microsoft Suite, SQL, SAS, Tableau, Power BI, Qlik, Alteryx
• May represent GHP/Network Management department on cross-functional projects or initiatives

JOB SUMMARY

The Network Pricing Analyst participates and assesses network pricing strategy as well as the execution, implementation, and optimization of current, new, and future network / pricing innovation. Assists in creation and maintenance of complex financial modeling and process development to establish business insight, quality assurance, and execution to achieve departmental goals.

In partnership with team leaders and members, supports the development of reimbursement strategy, execution of network pricing, and perform pharmacy analytics reporting and modeling that fall under the Maximum Allowable Cost (MAC) Management umbrella.

Provide support as needed with GHP NetOptimizer consulting opportunities.

Develops capabilities specifically targeted to achieve the efficient and effective application of the company’s products and services toward the achievement of total cost savings and improved health outcomes for the company’s clients and their members.

ESSENTIAL FUNCTIONS

(These duties must be performed with or without reasonable accommodation. This document in no way states or implies that these are the only duties to be performed by the employee occupying this position)

• Assist in development of business, industry, competitive, client, and technical knowledge to formulate pricing strategy, and to execute financial modeling of comprehensive pricing strategies
• Desire to be creative and solve complex data analytical problems that assist in business processes
• Ability to read/write queries and establish workflows in order to offer and implement continued automation and improvement
• Provide assistance / coordinate with all Network Management team members in weekly process tasks. Included but not limited to:
  • Pharmacy pricing appeals – Includes receiving and sending communications from pharmacies and compiling specific data for automated processes to utilize
  • Run weekly automated pricing tasks to ensure pricing process accuracy and implementation
  • Gather input data for weekly process from pricing resources, governmental resources and medical/pharmaceutical data
  • Creating procedural documentation to cover all automation and analytical tasks for audit/compliance needs
  • Review and interpret State Legislation, Pharmacy contracts and Client contracts for ongoing management throughout processes
• Execute and implement dynamic pricing strategies in response to market fluctuations to provide competitive, profitable, and best of class pricing offerings
• Ability to create as needed reporting procedures to assist in team’s automation needs
• Assist in ongoing MAC management pricing process
• Effective communication in providing clear and concise responses to Network Pricing / MAC related RFP inquiries
• Utilize and maintain domain expertise across levers of PBM financials, including retail networks, dispensing, specialty drugs, pharmaceutical manufacturer rebates, MAC pricing, and our product offerings
• Proven ability to collaborate effectively with a cross-functional team to align and coordinate internal resources. In addition, coach, lead, mentor and assist with staff career development
• Proactive identification and closure of network gaps as well as development of performance reports
• Support GHP’s NetOptimizer consulting opportunities. Included but not limited to:
  • Creating Client Specific Presentations
  • Data Management / Reporting
  • MAC Evaluations
  • Repricing / Savings Analyses
• Desire to excel in data analytics, pricing, process automation, pricing and healthcare financials
• Promptly report any allegations of impropriety to the Compliance Department
• Comply with Gateway’s Ethical Business Conduct policy and Gateway’s Compliance Program
• Remain free from exclusion under the OIG and SAMS Medicare/Medicaid lists
• Complete required training, as assigned, within the established timeframes
• Must be able to cope with the mental and emotional stress of the position
• Perform other job-related duties as assigned

PHYSICAL REQUIREMENTS

(With or without the aid of mechanical devices)

• Must be able to move intermittently throughout the day
• Must be able to speak the English language in an understandable manner
• Must be able to cope with the mental and emotional stress of the position
• Must possess the sight/hearing senses, or use prosthetics that will enable these senses to function adequately, so that the requirements of this position can be fully met
• Must function independently, have personal integrity, have flexibility, and the ability to work effectively with other staff
• Must be in good general health and demonstrate emotional stability
• Must be able to operate office, business, and accounting machines

WORKING CONDITIONS

• Sitting, standing, bending, lifting, and moving intermittently during working hours
• Works in well lighted/ventilated office areas
• Subject to frequent interruptions
• Willingness to work beyond normal working hours, and in other positions temporarily, when necessary
• Attend and participate in continuing educational programs
• Communicates with both external and internal customers

COMPANY

We are transforming the pharmacy industry to create healthier lives through purposeful engagement across Pharmacy Benefit Management, Pharmacy Management, Specialty Pharmacy, 340B, Rebate and Formulary Management, and Pharmacies. We put people first and are committed to providing outstanding service across all aspects of our business. Our goal is to create flexible and innovative solutions filled with inspired possibilities.

LOCATIONS

Our team brings robust experience, diverse perspectives and passion from a nationwide team of 900+ professionals located in more than half of the US states.

WHY JOIN OUR TEAM?

Gateway offers a progressive culture that supports a work from home model, a “dress for your day” attire, and a collaborative, team oriented environment. We offer a comprehensive compensation & benefits package including:

• $750 individual, annual medical deductible, $25 office visit copays
• Low biweekly premiums
• Company paid basic life/AD&D, Short-term and Long-term disability insurance
• Rx, dental, vision, short-term disability, and FSA
• Employer-matched 401k Plan
• And more!

The innovative spirit at Gateway will transform the way you think about pharmacy & healthcare services. As we pave the way in a relentless commitment to positive health outcomes, it’s never been a better time to be part of our team!

Gateway is an EEO / AA / M / F / Vets / DisabilityInterested in this Career?   Email Human Resources