Pharmacy Reimbursement Analyst
The University of California, San Diego
About this position
Position Description
The Pharmacy Analyst supports retail pharmacy operations by analyzing financial, operational, and clinical data to improve performance, control costs, ensure regulatory compliance, and optimize patient access and service delivery. This role partners with pharmacy leadership, finance, operations, and IT teams to provide insights that drive data-informed decision-making across retail pharmacy locations. Responsibilities include: Pharmacy workflows: prescription life cycle, roles and responsibilities of pharmacy personnel as well as scope of practice, medication access. Pharmacy finance and business models: third party billing, PBM contract and reimbursement models, Part D plan design. Specialty pharmacy: LDD access, biosimilars, patient assistance programs, cash flows and margins. Regulatory & compliance: Medicare, Medicaid, 340b program, predictive analysis, dashboards Business Intelligence: Advanced Excel, SQL, Data QA, Python. Health Information Systems: EPIC/ WAM, claims reconciliation platforms, accounts receivable. Automation: RPA, Automation impact analysis (pre and post deployment), automation impact analysis and prioritization of use cases.
Qualifications
Seven (7) years of related experience, education/training, OR a Bachelor’s degree in related area plus three (3) years of related experience/training. Related experience: Prescription lifecycle and reimbursement from payors and patient payment options. Demonstrated knowledge of healthcare reimbursement revenue cycle workflow, financial reporting, net revenue analysis and budgeting to effectively and independently capture revenue. Strong skills in data management and analysis. Ability to manage a project through from inception to completion on schedule while performing a wide variety of tasks, adapting to changing priorities, deadlines and directions. Thorough knowledge of financial analysis, research, and reporting, particularly as it applies to reimbursement in healthcare settings. Strong interpersonal skills, with the ability to collaborate effectively on complex projects in a team environment with staff from a wide variety of business and clinical areas. Strong communications skills, with the ability to interpret and convey finance information in a clear, concise manner. Ability to prepare compelling and informative reports and presentations. Ability to perform all commonly applicable functions in word processing and spreadsheet software.
Job Location
Jacobs Medical Center