Pharmacy Compliance Analytics Lead

Healthfirst; New York (NY); On-site; USD 138,000 - 155,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision coverage

Life insurance

401(k) contributions

Job summary

Healthfirst is seeking a Senior Pharmacy Compliance Reporting Analyst in New York to strengthen regulatory adherence across Pharmacy Operations. The role focuses on risk analysis, MTM program reporting, and data-driven insights to improve compliance and outcomes.

You will partner with PBM and internal teams, develop automated reporting solutions, and support audits while ensuring timely, accurate communications and governance across the program.

Qualifications

• 5 years of experience gathering, analyzing and communicating complex analytical requirements to diverse audiences across teams.
• 5 years of experience developing and utilizing reports and dashboards to measure product performance.
• 5 years of experience using BI/reporting tools (Base SAS, SAS EG, Tableau, Aginity Workbench, SQL Server, Management Studio) for advanced analysis, visualization and data integrity.
• 5 years of experience managing multiple concurrent projects with Finance, Benefits, Utilization Management, Regulatory and Compliance, and Specialty Pharmacy.
• 5 years of experience writing scalable, maintainable code following best practices.

Responsibilities

• Promote compliance by analyzing, identifying, and addressing risks to regulatory requirements.
• Collaborate with other departments to drive implementation, execution and monitoring of regulatory strategies for Pharmacy Operations.
• Support the Director of Pharmacy Operations to ensure PBM and other vendors adhere to federal and state regulations.
• Run monthly MTM member identification and support MTM reporting; ensure timely reporting for outreaches and measure success.
• Ensure data integrity for day-to-day operations and develop program insights and analytics tools.
• Enhance and automate compliance reporting solutions, including data collection, validation, governance and reporting.
• Develop analytics for risk detection, profiling, and mitigation using advanced statistical techniques.
• Identify enrollees for MTM enrollment on a monthly basis and assist with monitoring approvals/rejections.
• Oversee language, content and timeliness of enrollee/provider/pharmacy communications per regulatory expectations including OIG/OMIG lists and formulary changes.
• Represent the department to ensure compliance with Transparency in Coverage Rule.
• Participate in internal and external audits and deliver ad-hoc reporting to identify inefficiencies.

Skills

Analytical thinking

Stakeholder communication

Regulatory knowledge

Project management

Problem solving

Tools

Base SAS

SAS EG

Tableau

Aginity Workbench

SQL Server

Management Studio

Job description

Healthfirst is seeking a Senior Pharmacy Compliance Reporting Analyst in New York to strengthen regulatory adherence across Pharmacy Operations. The role focuses on risk analysis, MTM program reporting, and data-driven insights to improve compliance and outcomes.

You will partner with PBM and internal teams, develop automated reporting solutions, and support audits while ensuring timely, accurate communications and governance across the program.