Pay Range:
$75.00hr - $80.00hr Job Overview: The purpose of the position is to identify and resolve compliance and eligibility issues with contracted managed care customers. This position works with the Market Access account managers and the contracted account to gain alignment on formulary product placement and compliance and to recover previously paid rebate or discounts in the event of noncompliant formulary findings. Reporting to the Senior Manager, Contract & Formulary Compliance, the successful candidate will be responsible for identifying and investigating formulary positions on PBM and Health Plan websites and formal Pharmacy Drug Lists (PDL) to validate that product placement complies with all terms and conditions of the managed care contract. Using critical thinking skills and data analytics, the successful candidate will complete complex investigational audit reviews, identify risks and compliance issues, and present findings both verbally and in writing to key internal and external stakeholders.
Responsibilities:
Establish an audit plan to review assigned account formularies across Commercial, Medicare Part D, and medical channels. Review products on each formulary and assess compliance with the stated terms and conditions of contract; request and obtain supporting documentation (e.g., prior authorizations, step edits etc.) as needed to complete the assessment.
Required Qualifications:
Thorough understanding of Managed Care contracting as it relates to formulary access and tier positioning. Industry understanding of step-edits, NDC blocks, prior authorizations, copay differentials, preferred and non-preferred status. Ability to articulate a comprehensive understanding of contract terms and conditions. Advanced understanding of pharmaceutical rebate flow and decision points. 340B knowledge is a plus. Minimum of 3+ years of experience in financial analysis. Minimum of 2+ years of experience working with drug formularies. Superior skills in Excel and PowerPoint. Pharmaceutical industry experience is required. Managed Care experience rather than rebate experience.
Preferred Qualifications:
Experience in brand pharmaceutical business, specifically in market access, rebate operations, and/or pharmaceutical contract compliance. Strong negotiation and presentation skills. Understanding of drug purchase discounts and their interaction with prescription-based rebates.
Education: Bachelor's Degree in Finance or other business-oriented field is required.
Benefits:
Our Benefits Include: Medical, Dental, and Vision Insurance 401(k) Retirement Plan Health Savings Account (HSA) Disability Insurance (Short-Term and Long-Term) Life and AD&D Insurance Paid Sick Leave (where required by applicable state or local law) Supplemental Insurance Plans Identity Theft Protection Pet Insurance Employee Wellness Programs Employee Assistance Program (EAP) Career Growth and Professional Development Opportunities Disclaimer: Benefits eligibility, accrual rates, and usage limits may vary based on employment status, length of service, and work location. Paid Sick Leave is provided in strict accordance with applicable state and municipal mandates. Cynet Systems Inc. reserves the right to modify, amend, or terminate any benefit plans at any time in accordance with applicable laws. About Cynet Systems Founded in 2010 and headquartered in the Washington, DC metro area, Cynet Systems Inc. is a leading technology staffing and workforce solutions company serving Fortune 500 companies, government agencies, and enterprise organizations across the United States and Canada. We deliver agile, scalable talent solutions across IT, engineering, life sciences, clinical, and professional staffing, powered by a high-performing recruitment engine operating across North America and Asia. As a nationally and locally certified Minority Business Enterprise (MBE), Cynet Systems is committed to helping organizations build high-performing teams while empowering professionals to grow rewarding careers. Our organization is certified to ISO 9001, ISO 14001, ISO 27001, and SOC 2 Type II standards, reflecting our commitment to quality, security, operational excellence, and customer success.
