Pharmacy Configuration Analyst

Your career starts now. We’re looking for the next generation of health care leaders.At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.Discover more about us at .Job SummaryThe Pharmacy Configuration Analyst ensures pharmacy administration deliverables are executed thoroughly for all vendors utilized by PerformRx. As an expert for pharmacy claims configuration, the analyst will review, code, validate, and provide consultation on end-to-end pharmacy claim adjudication for all lines of business (Commercial, Medicaid, and Medicare).Essential Functions:Supports configuration deliverables for all in-house modular pharmacy management through all PerformRx vendors. Follows department validation processes for all requests that may require test plan execution. Provides metric reports of configuration deliverables for all PerformRx vendors.Works in a team setting to accomplish large scale new business and client reimplementation projects for clinical, benefits, and network configuration designs.Research pharmacy claims processing configuration related capabilities. Makes recommendations for fulfilment of basic to moderately complex configuration requests, including presenting these recommendations to management and clients upon request.Troubleshoots reported coding defects and provides detailed summary of analysis and all available solutions for immediate mitigation with all PerformRx vendors.Participates in configuration training and best practice discussions as new capabilities are added to all PerformRx vendors.Provides consultation to all PerformRx vendors on improvements to user interface and capabilities.Assists in the organization and documentation of benefit design specifications in a standardized, client-facing format.Participates in audits related to claim processing configuration parameters.Experience/Education:Bachelor’s Degree.3 or more years PBM, pharmacy operations, or claims processing experience required.Other Skills:Strong knowledge of Medicaid, Medicare, Exchange, and Commercial related pharmacy claims processing designs.Knowledge of pharmacy claims processing programs such as, but not limited to, Coordination of Benefits, Dispensed as Written, Custom and Part-D transition, Fill Limits, and Provider Restrictions.Knowledge of health plan pharmacy formulary and DUR maintenance processes.Knowledge of medical and pharmacy-combined accumulator designs.Proficient in MS Office (Outlook, Word, Excel, PowerPoint, Teams).Supports and carries out the PerformRx Mission & Values by maintaining current knowledge base of PerformRx programs, services, policy, and procedures, and adhering to all AmeriHealth Caritas and PerformRx policies and procedures.Our Comprehensive Benefits PackageFlexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.

Created: 2025-11-07