Job Description

This position is responsible for reviewing and resolving MAC pricing inquiries from retail pharmacies and state government agencies. This includes tracking all MAC appeals received and assigning to appropriate Coordinators for priority review to ensure 100% compliance with MAC legislations. It also includes running queries using SAS and ACCESS programs to perform various MAC related analyses, and identifying & forwarding potential issues to pharmacists for review in order to minimize impact to pharmacies and plan members. This position is also responsible for supporting IT in MAC Appeals Database development/improvement initiatives, responding to inquiries received from the account team, mentoring/training Coordinators, and scheduling daily tasks.

Required Qualifications

3+ years of professional work experience

COVID Requirements

COVID-19 Vaccination Requirement

CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

Preferred Qualifications
Knowledge and experience with pricing
Experience with Rx Claim
Experience with claims research
Computer skills including MS Access, Excel, and ability to run SAS programs
Excellent writing skills

Education
Bachelor’s Degree preferred or equivalent experience

Business Overview

Bring your heart to CVS Health

Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

We strive to promote and sustain a culture of diversity, inclusion and belonging every day.

CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.