Millions of times a day, CVS Health is helping people on their path to better health - from advising on prescriptions to helping manage chronic and specialty conditions.
This position is a part of our MAC team. Here you are responsible for all aspects of MAC list maintenance. This includes creating new MAC lists and managing existing MAC lists, uploading MAC prices to the adjudication platform and all MAC related QC processes. The MAC team works closely with the Finance Guarantee team to help ensure client commitments are met by making MAC adjustments as appropriate. The MAC team is also responsible for reviewing and responding to all pharmacy MAC appeals and working with the Legal team to respond to any MAC related complaints from state agencies. In addition, the MAC team monitors pharmacy GER guarantees and making MAC adjustments as needed. The MAC team is also responsible for all MAC related reporting, including client and pharmacy reports.
Additional responsibilities include:
Reviewing and resolving MAC pricing inquiries from pharmacies (both MAC law states and non MAC law states) and comply with MAC law requirements.
Validating information from various sources such as Medispan, manufacturers and wholesalers.
Accurately update Pharmacy Inquiry Database with appropriate information and respond to pharmacies within required TAT.
Identify marketplace condition changes and quickly forward potential issues to pharmacists for review in order to minimize impact to pharmacies and plan members.
Maintain MACPRICE email box and respond to pharmacy phone calls as required by state laws.
Knowledge and experience with pricing
Excellent attention to detail
Problem solving skills
Ability to multi-task
Experience with Rx Claim
Experience with claims research
Verifiable High School diploma or GED is required. Bachelor's Degree preferred
It's a new day in health care.
Combining CVS Health and Aetna was a transformative moment for our company and our industry, establishing CVS Health as the nation's premier health innovation company. Through our health services, insurance plans and community pharmacists, we're pioneering a bold new approach to total health. As a CVS Health colleague, you'll be at the center of it all.
We offer a diverse work experience that empowers colleagues for career success. In addition to skill and experience, we also seek to attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity and accountability.
CVS Health is an equal opportunity/affirmative action employer. Gender/Ethnicity/Disability/Protected Veteran we highly value and are committed to all forms of diversity in the workplace. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT. We provide reasonable accommodations to qualified individuals with disabilities. If you require assistance to apply for this job, please contact our Advice and Counsel Reasonable Accommodations team. Please note that we only accept applications for employment via this site.
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