Note: The job is a remote job and is open to candidates in USA. EmpiRx Health is a clinically driven pharmacy benefits management company focused on improving pharmacy care, healthcare outcomes, and financial results. The Network Analyst supports pharmacy network pricing execution, benefit plan and network configuration, manual pricing updates, implementation activities, quality assurance, data analysis, documentation, and cross-functional issue resolution.
Responsibilities
- Implement assigned benefit plan, pricing, network, and reimbursement configurations in accordance with approved direction and documented requirements
- Complete manual pricing changes, MAC updates, pricing table updates, and related operational tasks accurately and within expected timelines
- Validate pricing setup, reimbursement logic, and configuration outputs to confirm that changes were implemented as intended
- Research pricing or configuration discrepancies, document findings, and escalate risks or questions to Network Operations leadership when appropriate
- Support ongoing maintenance of client pricing, network configuration, and related operational records
- Support new client implementations, renewals, and plan changes by completing assigned configuration, pricing, testing, and validation activities
- Follow QA procedures to verify benefit plan setup, pricing configuration, reimbursement logic, and claim adjudication outcomes across applicable platforms
- Document implementation results, testing outcomes, defects, remediation steps, and lessons learned to support repeatable execution
- Coordinate with Network Operations, Implementation, Client Experience, Product, and other internal teams to resolve assigned implementation or configuration issues
- Maintain attention to detail and accuracy when working through high-impact pricing and implementation tasks
- Use Excel and available reporting tools to review claims, pricing, utilization, reimbursement, and client performance data
- Perform assigned ad-hoc analysis to help research client performance changes, pricing questions, pharmacy reimbursement issues, or operational variances
- Apply mathematical and analytical reasoning to validate pricing outputs, compare reimbursement scenarios, and identify potential data or configuration issues
- Prepare clear summaries of findings, open questions, and recommended next steps for review by Network Operations leadership
- Develop working knowledge of MAC pricing principles, pharmacy reimbursement concepts, effective rate calculations, and commercial PBM pricing operations
- Create and maintain process documentation, configuration notes, implementation checklists, QA evidence, MAC update templates, and related operational records
- Follow established SOPs and contribute updates when process gaps, recurring issues, or improvement opportunities are identified
- Research benefit plan, pricing, configuration, contract, or regulatory questions as assigned and escalate unclear items with supporting detail
- Work independently while communicating status, risks, blockers, and questions clearly to leadership and cross-functional partners
- Support a culture of accuracy, accountability, documentation, collaboration, and continuous improvement within Network Operations
Skills
- • Bachelor's degree required or equivalent relevant work experience as determined by HR and business leadership
- • 2+ years of experience preferably in PBM operations, healthcare operations, benefit plan setup, pricing configuration, reimbursement operations, claim adjudication, or a related field
- • Experience working with benefit plan, pricing, reimbursement, network, claim, or other operational configuration processes
- • Strong attention to detail and ability to complete manual configuration or pricing updates accurately
- • Ability to work independently, manage assigned work, follow documented procedures, and escalate questions or risks appropriately
- • Intermediate to advanced Microsoft Excel skills, including formulas, lookups, pivot tables, data validation, and large dataset review
- • Analytical and mathematical problem-solving skills with the ability to investigate variances, validate outputs, and summarize findings clearly
- • Strong written and verbal communication skills, including the ability to document work clearly and explain operational issues to internal stakeholders
- • PBM, pharmacy network, managed care, healthcare claims, or prescription benefit operations experience
- • Experience setting up or validating benefit plans, pricing configurations, reimbursement logic, or network configurations in a claim adjudication platform
- • Experience completing manual pricing changes, MAC updates, pricing table maintenance, or related operational updates
- • Familiarity with pharmacy reimbursement concepts, MAC pricing, effective rate calculations, AWP-based pricing, dispensing fees, or client guarantee monitoring
- • Experience with reporting or analytics platforms such as Power BI, Tableau, SQL, Databricks, Domo, or similar tools
- • Experience creating process documentation, QA checklists, implementation notes, technical requirements, or operational templates
Benefits
- Remote work arrangement
- Subject to program eligibility, Paid Time Off
- Subject to program eligibility, a 401(k) program
- Subject to program eligibility, Health Insurance including Dental & Vision coverage
- Subject to program eligibility, Health Savings Account
- Subject to program eligibility, an Employee Assistance Program
Company Overview