We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Position Summary
The Industry Analysis Coordinator is responsible for supporting all aspects of Maximum Allowable Cost (MAC) list maintenance and analysis. This includes creating new MAC lists, managing existing MAC lists, uploading MAC pricing to the adjudication platform, and performing all MAC-related quality control activities.
Working closely with the Finance Guarantee team, this role helps ensure client commitments are met through appropriate MAC pricing adjustments. The Industry Analysis Coordinator is responsible for reviewing and responding to pharmacy MAC appeals, collaborating with the Legal team to address MAC-related inquiries and complaints from state agencies, and monitoring pharmacy GER guarantees to identify and recommend pricing adjustments as needed.
This position also supports MAC-related reporting activities, including the preparation and distribution of client and pharmacy reports, while helping ensure pricing accuracy, regulatory compliance, and timely resolution of pharmacy inquiries.
Responsibilities Include
- Reviewing and resolving MAC pricing inquiries from pharmacies (both MAC law states and non-MAC law states) and complying with MAC law requirements.
- Validating information from various sources, such as Medi-Span, manufacturers, and wholesalers.
- Accurately updating the Pharmacy Inquiry Database with appropriate information and responding to pharmacies within required TAT.
- Identifying marketplace condition changes and quickly forwarding potential issues to pharmacists for review in order to minimize impact to pharmacies and plan members.
- Maintaining the MACPRICE email box and responding to pharmacy phone calls as required by state laws.
Required Qualifications
- 1+ years of professional work experience in pharmacy claims
- 1+ years of MS Office experience
Preferred Qualifications
- Experience with RxClaim
- Bachelor's Degree
- Access Database
- SAS
Education
High School diploma or equivalent GED.
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$17.00 - $31.30This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- 1+ years of professional work experience in pharmacy claims
- 1+ years of MS Office experience
- High School diploma or equivalent GED
- Experience with RxClaim
- Bachelor's Degree
- Access Database
- SAS
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
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