Job description

PDMI is looking to add a Pharmacy Network Operations Analyst to our team! This role supports the analysis, maintenance, and ongoing optimization of PDMI’s Pharmacy and Client Networks, contributing to network design, pricing strategies, MAC operations, and issue resolution through detailed data analysis and system updates. Since 1984, PDMI has provided pharmacy data processing and other flexible, scalable solutions to help our clients meet their business objectives. We offer transparent, pass-through pharmacy processing and other services for private label Pharmacy Benefit Managers (PBMs), vertically integrated health plans and hospital systems. In addition to Pharmacy Benefit Administrative Services, we offer 340B Administration, Hospice and Long-Term Care Services.   Why Join Us:   • Best Employer:  PDMI was voted Best Employer in Ohio for the sixth consecutive year in 2026!   • Meaningful Work:  Contribute to improving healthcare quality and efficiency.   • Collaborative Environment:  Work with passionate professionals who share your drive.   • Exciting Challenges:  Every day brings new opportunities to excel.   • Flexible Work:  Fully remote opportunity with a company that cares.   Key Responsibilities:   • Acquire and maintain a strong understanding of the pharmacy network structure, rates, MAC pricing, provider demographics, and related operational components.  • Assist in maintaining and updating pharmacy network design, pharmacy demographic data, MAC operations, reimbursement methodologies, and network-related system updates.  • Provide guidance on pricing strategies, and implementation considerations for pharmacy reimbursement.  • Conduct research and analysis on claims, pharmacy inquiries, MAC-related issues, and other pricing or reimbursement discrepancies.  • Develop and maintain operational audit tools, provide corrective action follow-up, and support audit activities across the network.  • Create analytical and operational reports related to network performance, MAC activity, Audit claims, pharmacy operations, and client-specific requests.  • Lead or support ad-hoc analysis and reporting to assist internal stakeholders in network decision-making.  • Assist with establishing and updating procedures related to accurate claims adjudication and network maintenance.  • Participate in policy and procedure development for Pharmacy Network operations and support continuous improvement initiatives.  • Build collaborative relationships with internal departments to ensure accurate implementation of network contracts, pricing, and related updates.  Qualifications – Education, Experience, Certifications:   • Bachelor’s degree in Health Administration, Healthcare Analytics, Business, Finance, or a related field or equivalent industry experience required.  • 3+ years of pharmacy network experience preferred.  • Database development and reporting experience using SQL, TOAD, or similar tools required.  • Strong data analysis and data manipulation skills required; pharmacy data analysis experience preferred.  AI Usage & Candidate Authenticity:  AI tools may be used for resume formatting or drafting application materials; however, submitting content that misrepresents your experience, including copied job descriptions or unverifiable work history, is not acceptable. Candidates must be prepared to clearly and confidently speak to all experience listed. PDMI may request work samples, portfolio links, or other forms of validation during the process. Use of AI tools during interviews or assessments, unless explicitly permitted, will result in disqualification.  All offers are contingent upon successful completion of a pre-employment background check, including employment and education verification, as well as a 4-panel drug screen.

Requirements

Must-haves

Acquire and maintain a strong understanding of the pharmacy network structure, rates, MAC pricing, provider demographics, and related operational components.
Assist in maintaining and updating pharmacy network design, pharmacy demographic data, MAC operations, reimbursement methodologies, and network-related system updates.
Provide guidance on pricing strategies, and implementation considerations for pharmacy reimbursement.
Conduct research and analysis on claims, pharmacy inquiries, MAC-related issues, and other pricing or reimbursement discrepancies.
Develop and maintain operational audit tools, provide corrective action follow-up, and support audit activities across the network.
Create analytical and operational reports related to network performance, MAC activity, Audit claims, pharmacy operations, and client-specific requests.
Lead or support ad-hoc analysis and reporting to assist internal stakeholders in network decision-making.
Assist with establishing and updating procedures related to accurate claims adjudication and network maintenance.
Participate in policy and procedure development for Pharmacy Network operations and support continuous improvement initiatives.
Build collaborative relationships with internal departments to ensure accurate implementation of network contracts, pricing, and related updates.
Qualifications – Education, Experience, Certifications:
Bachelor’s degree in Health Administration, Healthcare Analytics, Business, Finance, or a related field or equivalent industry experience required.
Database development and reporting experience using SQL, TOAD, or similar tools required.
All offers are contingent upon successful completion of a pre-employment background check, including employment and education verification, as well as a 4-panel drug screen.

Nice-to-haves

3+ years of pharmacy network experience preferred.
Strong data analysis and data manipulation skills required; pharmacy data analysis experience preferred.

Application prep

Use the role’s language and application details while tailoring your materials.

Keywords to mirror

sqlai

Platform: breezy
Effort: medium