Pharmacy Network Operations Analyst

About the role

PDMI is seeking a Pharmacy Network Operations Analyst to support analysis, maintenance, and optimization of its Pharmacy and Client Networks, contributing to network design, pricing strategies, MAC operations, and issue resolution.

Key responsibilities

• Maintain understanding of pharmacy network structure, rates, MAC pricing, and provider demographics.
• Update network design, demographic data, MAC operations, reimbursement methodologies, and system updates.
• Provide guidance on pricing strategies and reimbursement implementation.
• Research and analyze claims, pharmacy inquiries, MAC issues, and pricing discrepancies.
• Develop and maintain operational audit tools and support audit activities.
• Create analytical and operational reports on network performance, MAC activity, and client requests.
• Lead or support ad‑hoc analysis for internal stakeholders.
• Assist in establishing procedures for accurate claims adjudication and network maintenance.
• Participate in policy development and continuous improvement initiatives.
• Collaborate with internal departments to ensure accurate contract and pricing implementation.

Required profile

• Bachelor’s degree in Health Administration, Healthcare Analytics, Business, Finance, or related field, or equivalent experience.
• 3+ years of pharmacy network experience preferred.
• Strong data analysis and manipulation skills.

Required skills

• SQL
• TOAD or similar database reporting tools

What we offer

• Best Employer award in Ohio for six consecutive years.
• Opportunity to improve healthcare quality and efficiency.
• Collaborative environment with passionate professionals.
• Fully remote work arrangement.