PBM Regulatory Reporting Analyst

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ExactCare

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2009

⚕️ Healthcare Insurance

💊 Pharmaceuticals

💰 Private Equity Round on 2016-03

Healthcare Insurance • Pharmaceuticals

ExactCare is a leading pharmacy care management provider that specializes in medication management for individuals with complex, chronic medical needs. With operations in all 50 states and Washington, D. C. , ExactCare supports more than 100,000 people nationwide, helping them manage their medications in assisted living, long-term care facilities, and at home. Partnering with healthcare organizations, ExactCare aims to improve clinical outcomes by ensuring better medication adherence, reducing readmissions, and lowering overall healthcare costs.

📋 Description

• Assist with compiling Quarterly Pharmastar Compliance reports • Assist with preparation and analysis of PDE, PDE Rejections, FIR reports, and plan rebate reports • Assist with PACE Bid preparation, including working with external auditors • Assist with weekly Financial Billing, plan admin fees, pharmacy network payment review reporting and activities • Handle Action Required reporting, associated member authorizations and related activity • Create NDPDP Pharmacy Encounter data file preparation, testing and submission, and error review • Assist with QA of existing reports and adjudication results • Review report output for issues for proactive recommendations for change • Respond to internal ticketing system requests and inquiries • Generate reports to meet clients’ needs and internal support needs and make updates where appropriate • Ensure that HIPAA guidelines are followed in every communication with clients • Stay current on plan and benefit structures, pharmacological updates, and Medicare Part D guidelines • Attend department and company meetings and educational programs upon request • Other related duties as assigned.

🎯 Requirements

• Associate’s degree preferred • High School Diploma or equivalent required • 1+ years of audit/quality and PACE industry experience • 2 years of Healthcare industry experience, required • Health plan or insurance experience, a plus. PBM experience preferred • CPhT (Certified Pharmacy Technician) certification, a plus • Experience in a pharmacy support role, a plus • Proficiency in Microsoft Excel required • A strong understanding of TOAD, SSRS, or T-SQL, a plus

🏖️ Benefits

• Medical, dental and vision coverage are effective 1st of the month following date of hire • Flexible spending • Company-paid life insurance and short-term disability • 401(k) • Paid Time Off • Paid holidays