Apply on Employer Site

Abarca Health · 7 hours ago

Pricing Manager

United States

Full-time

Remote

Senior Level, Lead/Staff

8+ years exp

Abarca Health is igniting a revolution in healthcare by redefining pharmacy benefits through smarter technology. As the Pricing Manager, you will lead Abarca’s Maximum Allowable Cost (MAC) program, ensuring accurate and timely generic reimbursement while protecting the financial interests of the company and its clients.

Health CareInformation Technology

No H1B

Responsibilities

Own MAC strategies, and work to transform MAC strategies in MAC pricing lists for retail, mail, specialty, and LTC

Implement robust MAC QC process including evaluation of outliers, review of impactful changes, peer review process

Analyze client and pharmacy guarantee performance and consult with a cross-functional team to craft strategies that generate savings for Abarca clients

Set/tune methodology using NADAC, WAC, AMP, acquisition-cost proxies, floors/minimums, and dispensing-fee logic

Operate MAC under third-party leased-network rules (update cadence, file formats, distribution, communications)

Develop performance-guarantee dashboards, and monitor and report out performance to the Pricing Oversight Committee

Collaborate cross-functionally to stay highly aware of pharmacy network contracting and generic Maximum Allowable Cost (MAC) pricing strategy to ensure it aligns with the underwriting strategy

Work in Snowflake and within the Darwin platform to identify claims with aberrant pricing and validate accurate application of MAC

Own investigations, reporting, and responses related to any audit questions related to MAC pricing

Work with the underwriting team to help determine MAC strategies for prospective and new clients

Monitor unit cost trend, spread, GER/BER, and outliers; produce monthly MAC scorecards (savings, appeal TAT/overturns, cycle time, top movers)

Interpret state MAC statutes and CMS/Medicaid requirements; maintain SOPs, controls, and audit evidence; lead remediation when needed

Define data requirements and QC for Snowflake pipelines (NADAC refresh, vendor feeds, wholesaler invoice ingestion)

Qualification

MAC strategiesPBM pricing knowledgeSQL (Snowflake)Data analysisTableau/Power BIGeneric pricing leversNADACWACAMP knowledgeAnalytical mindsetPythonCommunicationDocumentation skillsFlexibility