Senior Analyst, Payor Operations and Solutions

Job Summary

Analyzes complex data to support the decision making on individual proposals and contracts related to pharmacy programs. Data analysis may include new product pricing, product portfolio, profitability of new opportunities with current and new clients, impacts of regulatory changes, capital analysis, and profit margin analysis. Responsible for developing, implementing, on-going monitoring of strategies and tools to ensure 3rd party pharmacy programs are in compliance with contractual terms and conditions pertaining to designated product or service offering.

Job Responsibilities

• Researches, identifies, and improves applications, tools, and systems to fulfill reporting and analysis needs.
• Assists with new system rollouts and training to promote operational efficiency and productivity.
• Creates and maintains reports and portals to post, track, and report on initiatives, policies and procedures, departmental forms, and contracted policies and information within contracts.
• Implements complex processes of new third party plans and updates to ongoing third party plans; reviews and approves administrative paperwork prior to routing implementation information to the appropriate internal departments. Tracks and resolves post-implementation issues related to contracts and pricing.
• Reviews complex contracts and provides feedback to management regarding potential opportunities, immediate needs related to contracted terms and programs, resolves contract compliance issues and tracks financial impact. Responds to escalated issues.
• Develops complex financial models to support management decision-making related to new product development, product portfolio analysis, profitability of new opportunities, capital investments, revenue models, profit margin analysis, and impact of regulatory changes. Presents findings to managements and makes recommendations that are market competitive and fit with Walgreens' strategy.
• Performs complex ad hoc analysis and forecasts for internal management team and external customers.
• Responsible for the development and implementation of complex SOPs and acts as the subject matter expert on processes, procedures, and functionality
• Develops and maintains client relationships by providing services required to meet client needs while monitoring operational policies and procedures; reports gaps in client service and business issues of non-compliance to management.
• Assists field personnel and management in resolving member issues

About Walgreens
Founded in 1901, Walgreens ( proudly serves nearly 9 million customers and patients each day across its approximately 8,500 stores throughout the U.S. and Puerto Rico. Walgreens has approximately 220,000 team members, including nearly 90,000 healthcare service providers, and is committed to being the first choice for pharmacy, retail and health services, building trusted relationships that create healthier futures for customers, patients, team members and communities.

Basic Qualifications

• Bachelor's degree and at least 1 year of experience in healthcare industry field OR High School Diploma / GED and at least 4 years of experience in healthcare industry.
• At least 1 year of experience pharmacy or medical terminology and various reimbursement methodologies.
• At least 1 year of experience with third party plan set-up and implementation.
• Experience with analyzing and reporting data in order to identify issues, trends, or exceptions to drive improvement of results and find solutions.
• Experience using time management skills such as prioritizing/organizing and tracking details and meeting deadlines of multiple projects with varying completion dates.
• Experience providing customer service to internal and external customers, including meeting quality standards for services.
• Intermediate level skill in Microsoft Excel (for example: using SUM function, setting borders, setting column width, inserting charts, using text wrap, sorting, setting headers and footers and/or print scaling).
• Intermediate level skill in Microsoft PowerPoint (for example: applying a theme, formatting character spacing, inserting a picture, changing slide layout and theme colors, adding transitions, customizing slide numbers, changing chart style and/or formatting font).
• Intermediate level skill in Microsoft Word (for example: inserting headers, page breaks, page numbers and tables and/or adjusting table columns).
• Experience with project management and lean methodologies.
• Willing to travel up to 10% of the time for business purposes (within state and out of state).

Preferred Qualifications

• Advanced level skill in Microsoft Excel (for example: using AVERAGE function, merging and centering cells, printing centered page and/or creating a pivot table).
• At least two (2) years’ experience implementing contracted Third Party programs in the healthcare industry.
• At least two (2) years’ experience administering healthcare contracts.
• At least two (2) years Payor and facility credentialing experience.
• At least two (2) years medical reimbursement/fee schedule maintenance experience.
• Infusion, Specialty Pharmacy, Retail Clinic, and/or Pharmacy Technician experience.
• Experience using Walgreen proprietary systems (e.g. AS400, SIMS, POS, IC+)
• At least 2 years experience working in retail pharmacy operations.
• Experience providing customer service to internal and external customers, including meeting quality standards and evaluation of customer satisfaction.

We will consider employment of qualified applicants with arrest and conviction records.
Salary Range: $71400 - $114300 / Salaried