Pharmacy Data Analyst

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Full Time Clerical Wheeling, WV, US

3 days ago Requisition

The Pharmacy Data Analyst will help the operation of Pharmacy Services run more effectively and efficiently through analyzing data from multiple sources (e.g., Express Scripts, Databytes, Ipro) as well as extract trends and business insights to improve health and financial outcomes of The Health Plan's population. The Pharmacy Data Analyst will also assist the unit with the plan benefit management and coding of multiple lines of business (Commercial, Exchange, Medicaid, and Medicare) within the pharmacy benefit adjudication platform.

Required:

• Mustpossessabachelor’s or master’sdegreerelatedtodataanalyticsorat leastoneyear experience in pharmacy and medical claim data reporting.
• Proficient Microsoft Excel skills ,including pivottables,graphing,and complex formulas.
• Experienceindatacollection,analysis,andvisualizationmethods.
• Mustpossessaworkingknowledgeofqualityimprovementprinciples,theory,studydesignand statistical modeling.
• Flexibleandabletomulti-task,workinafast-pacedenvironmentandadapttochanging processes.
• Self-motivatedandgoaloriented.
• Abilitytoworkeffectivelyaspartofateamandindependently.
• Proficient keyboarding skills and computer literacy with the ability to navigate through multiple systems.
• Ability to exercise independent and sound judgment in decision making, utilizing all relevant information and data.
• Excellent oral,written,telephonicandinterpersonalskills,balancinganindependentandteam working environment.
• WorkingknowledgeofthePBMindustryandpharmacybenefitclaims.
• Experiencecreatingautomatedreports, self-servicetoolsandintegratingmultipledatainputs into a single dashboard (PowerBI).
• Skilledwithmathematicproblemsolvingandgraphing.
• Intermediatetoproficient skillsworkingwithSQLtoextractdata.
• PreviousexperienceworkinginPBMenvironment,health plan,ormanaged care service organization.

Responsibilities:

• Integrate data from multiple sources to produce requested or required data elements which support continuous quality improvement leading to actionable information.
• Assist pharmacy team members with complex, detailed data needed projects.
• Interpret, analyze,andproviderecommendationsregardingdataaccuracyanddatacollection needs and processes.
• Researchandidentifydataqualityissuesandworkwithinternalandexternalpartnerstocreate a resolution.
• Work with business unit(s) to identify opportunities to enhance existing processes and to developnewdatainformationprocessesandtools.
  
  Continuouslyassessandimprovedata collection and reporting processes.
• Interfacing with,gatheringinformationfrom,andpreparingdataforpresentationstovarious levels of management, committees, internal and external.
• Workwithdesignateddepartmenttoassess,define,anddevelopreportdeliverablestomeet internal and customer requirements.
• ReconciledailyeligibilityfilereportwithPBMandensurethattheeligibilityreporting procedure aligns with HEDIS measures.
• Understandandcalculateclientdrugpriceguarantees,adminfees,rebatesandotherterms related to pharmacy client and vendor contracts.
• ReviewfilesreceivedforPBMcompliancewithdataneeds,assistwiththedevelopmentof reports, testing files and configuring data in mapping tool.
• Createandmaintainthepharmacyexecutivemanagementfundsdashboard(drug spends, rebates, savings, PMF, etc.)
• Assist withauditingthePBMplanbenefitcodingandplanmaterialstoensurepharmacy benefits reflect the intent and/or client expectations.
• Assistinsubmittingandupdatingbenefitmaterialforinternalandexternalteams,suchas customer service applications.
• Assist with creating and recording impact reports from internal audit findings and work with PBM for solutions via corrective action plan.