Department

Job Title

Capital Rx is redefining the way prescriptions are priced and administered in the U.S. Capital Rx unlocks the pharmacy supply chain and reduces prescription costs for employer groups. By establishing a competitive marketplace for drug pricing, Capital Rx focuses its resources on deploying actionable strategies that improve plan performance and patient outcomes. The company's commitment to innovation, technology, and service is why Capital Rx is the fastest-growing pharmacy benefit manager in America.

Operations

Government Programs Senior Operations Analyst

Location: Remote (For Non-Local) or Hybrid (Local to NYC area)

Position Summary:

The Sr. Operations Analyst provides support gathering and documenting business and reporting requirements. This individual will analyze complex problems and issues using available information from both internal and external sources. Additional responsibilities will include – Creating specifications documents for reports, extracts, and analyses based on business needs. Identify and interpret trends in datasets to locate possible outliers or patterns that can be leveraged to drive process improvements. Collaborates with internal and external cross-functional teams (compliance, product, sales, marketing, underwriting, implementation, client services, clinical operations) to design, refine, automate, and maintain operational capabilities.

Position Responsibilities:

• Supports Capital-Rx in meeting and maintaining performance metrics as defined by client and regulatory guidelines – Including but not limited to encounter and PDE submissions
• Drives root-cause-analysis and resolution of PDE/encounter data issues/errors by partnering with key stakeholders to correct and resubmit data
• Supports analytical, problem-solving functions by defining and documenting specifications pertinent to all departmental processes
• Monitors for changes in existing business processes and updates documentation accordingly - Identifies new opportunities for process developments and improvements
• Proactively reviews business processes and data to develop subject matter expertise of processes supported by our team
• Analyzes business workflow and system needs for conversions and migrations to ensure that encounter, recovery, and cost savings regulations are met
• Prepares high-level user documentation and training materials as needed
• Collaborate with compliance to interpret and translate government reporting requirements into actionable recommendations/outputs
• Support encounter and PDE submission process by analyzing complex encounter data using data from internal and external sources
• Develop and establish PDE/encounter performance metrics for client and leadership distribution

Required Qualifications:

• 5+ years of healthcare data experience
• 5+ years of proven experience in government programs
• 3+ years of experience working with SQL, R, or Python
• 3+ years of business process analysis, preferably in healthcare
• Experience working with cross-functional teams
• Experience with Tableau, Excel, and other data visualization tools
• Ability to balance multiple complex projects simultaneously
• Extremely flexible, highly organized, and able to shift priorities easily
• Attention to detail & commitment to delivering high-quality work product

Preferred Qualifications:

• 3+ years of experience working with pharmacy processes
• Experience with Medicare, Medicaid, and Marketplace Exchange programs

Base Salary: $80,000 To $100,000

Nothing in this position description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

About Capital Rx

Capital Rx is a full-service pharmacy benefit manager (PBM) and pharmacy benefit administrator (PBA), advancing our nation’s electronic healthcare infrastructure to improve drug price visibility and patient outcomes. As a Certified B Corp™, Capital Rx is executing its mission through the deployment of JUDI®, the company’s cloud-native enterprise health platform, and a Single-Ledger Model™, which increases visibility and reduces variability in drug prices. JUDI connects every aspect of the pharmacy ecosystem in one efficient, scalable platform, servicing millions of members for Medicare, Medicaid, and commercial plans. Together with its clients, Capital Rx is reimagining the administration of pharmacy benefits and rebuilding trust in healthcare.

Capital Rx values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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