Abarca Health · 1 day ago
Pharmacy Network & Pricing Configuration Analyst
United States
Full-time
Remote
Mid Level
3+ years expAbarca is igniting a revolution in healthcare, focusing on redefining pharmacy benefits through smarter technology. As a Pharmacy Network & Pricing Configuration Analyst, you will be responsible for configuring and supporting pharmacy network participation and pricing logic, ensuring compliance with regulatory and client requirements.
Health CareInformation Technology
No H1B
Responsibilities
Serve as the primary support for pharmacy network and pricing configuration, including network setup, contracted rates, and pricing rules for new client implementations and existing plan changes
Configure and maintain pricing logic to ensure accurate claims adjudication aligned with client documentation and contractual agreements
Support configuration changes related to pharmacy network participation and pricing structures across multiple lines of business
Perform unit testing focused on network and pricing configuration, validating adjudication outcomes against expected pricing and network rules
Research and resolve claims adjudication issues related to network participation or pricing discrepancies, including root cause analysis, impact assessment, and corrective actions
Provide first-tier triage support for network and pricing-related claims processing issues within defined SLAs/SLOs
Collaborate with configuration peers, adjudication, product, and operational teams to execute accurate network and pricing configuration solutions
Take ownership of project-based configuration work, ensuring timelines and deliverables are met
Identify network and pricing functionality required to meet client outcomes and support implementation execution
Develop and maintain an in-depth understanding of Darwin (proprietary adjudication platform) logic related to pharmacy network and pricing configuration
Stay current with Medicare, Medicaid, and state regulatory requirements, ensuring network and pricing configurations remain compliant
Provide consultation and peer review for network and pricing configuration practices
Support the Sr. Analyst in documenting client plan standards, configuration processes, and operational procedures
Evaluate network and pricing configuration workflows and recommend process improvements
Qualification
Required
Associate or bachelor's degree. (In lieu of a degree, equivalent relevant work experience may be considered.)
3+ years of hands-on experience in PBM Pharmacy Network & Pricing configuration, including pharmacy network setup and pricing rule implementation
2+ years of experience within PBM operations, such as configuration, adjudication support, pharmacy networks, or Medicare-related functions
Experience using SQL and Excel to validate network participation and pricing outcomes in claims adjudication
Strong analytical skills with the ability to identify pricing and network-related issues and determine root cause
Excellent oral and written communication skills
Ability to collaborate effectively across technical and operational teams
Preferred
Experience with pharmacy network contracting, pricing models, or MAC list management
Experience in a healthcare non-retail pharmacy or PBM setting
Prior experience working directly with Darwin or similar adjudication platforms
Benefits
Flexible hybrid work model
Company
Abarca Health
Abarca Health is an information technology company that offers healthcare IT services
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Adriana Ramirez
President & COO
Recent News
News is my Business
2025-10-31
News is my Business
2025-03-27
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