Senior Pharmacy Compliance Reporting Analyst

🔥 14 hours ago

🦌 Connecticut, New Jersey, +1 more states – Remote

🦌 Connecticut – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote

💵 $137.6k - $155k / year

⏰ Full Time

🟠 Senior

📚 Business Intelligence Analyst

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Healthfirst

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1993

🛡️ Insurance

🏥 Healthcare

⚕️ Healthcare Insurance

Insurance • Healthcare • Healthcare Insurance

Healthfirst is a health insurance provider dedicated to helping New Yorkers access affordable health coverage for individuals and families. With over 30 years of experience, Healthfirst offers a range of plans including Medicaid managed care, Medicare Advantage, long-term care, and essential health plans. The company focuses on providing quality healthcare options, comprehensive benefits, and support to ensure members can maintain their health and well-being.

📋 Description

• Analyze, identify, and address risks to regulatory requirements • Collaborate across departments to implement, execute, and monitor Pharmacy Operations compliance strategies • Support the Director of Pharmacy Operations in overseeing PBM and delegated pharmacy vendors' adherence to federal and state regulations • Run monthly member identification for the Medication Therapy Management program and support MTM regulatory components and reporting • Ensure integrity of operational data and develop program insights and analytic tools • Enhance and automate compliance reporting solutions, including data collection, validation, aggregation, governance, and reporting • Develop analytical functions for risk detection, profiling, and mitigation using advanced statistical techniques • Identify and target enrollees for monthly MTM program enrollment • Support MTM outreach data requests and evaluate claims monitoring approvals, rejections, and timeliness • Oversee language, content, and timeliness of enrollee, provider, and pharmacy communications for regulatory compliance • Coordinate with internal stakeholders and PBM regarding non-binary gender identities • Represent the department for Transparency in Coverage Rule requests and requirements • Participate in internal and external audits • Deliver ad-hoc reporting solutions to identify compliance and operational inefficiencies

🎯 Requirements

• Bachelor's degree in computer science, information science, electrical engineering, or related field • 5 years of experience performing data management and analytics for managed care operations or as a pharmacy benefit manager • 5 years of experience gathering, analyzing and communicating complex analytical business requirements to diverse technical and non-technical stakeholders • 5 years of experience developing and utilizing reports and dashboards to analyze and measure product performance • 5 years of experience using Base SAS, SAS EG, Tableau, Aginity Workbench, SQL Server, and Management Studio • 5 years of experience performing advanced statistical analysis, creating interactive visualizations, managing databases, automating processes, and ensuring data integrity • 5 years of experience managing multiple concurrent projects supporting Finance, Benefits, Utilization Management, Regulatory and Compliance, and Specialty Pharmacy teams • 5 years of experience writing scalable, maintainable, well-documented, and supportable code • Applicants must meet all minimum requirements

🏖️ Benefits

• Medical, dental and vision coverage • Incentive and recognition programs • Life insurance • 401k contributions • Competitive compensation and benefits package