Pharmacy Data Analyst

Health Plan; West Virginia; Hybrid; USD 65,000 - 90,000; Full time

Job summary

The Health Plan is seeking a Pharmacy Data Analyst to optimize pharmacy services by analyzing data from diverse sources and extracting trends to improve health and financial outcomes. The role supports plan benefit management across Commercial, Exchange, Medicaid and Medicare lines within the pharmacy benefit adjudication platform.

Candidates should have a data analytics background, strong Excel and PowerBI skills, and experience with SQL for data extraction.

Qualifications

• Bachelor's or Master's in data analytics or related field, or 1+ year in pharmacy/medical claim data reporting.
• Proficient Excel skills including pivots, graphs and complex formulas.
• Experience in data collection, analysis and visualization methods.
• Working knowledge of quality improvement principles and study design.

Responsibilities

• Integrate data from multiple sources to support quality improvement and actionable insights.
• Assist pharmacy team with complex data needs and projects.
• Interpret and provide recommendations on data accuracy and collection needs.
• Identify data quality issues and coordinate resolutions with partners.
• Develop reports and dashboards to meet management and stakeholder requirements.
• Prepare data for presentation to various levels of management and committees.
• Develop additional data processes and tools to improve data collection and reporting.
• Assist with testing files and configuring data in mapping tools.

Skills

Data analytics

Excel

Pivot tables

Data visualization

PowerBI

SQL

Quality improvement

Teamwork

Communication

Independent judgment

Education

Bachelor's or Master's degree in data analytics or related field

Tools

Excel

PowerBI

SQL

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Pharmacy Data Analyst

Full Time Clerical Wheeling, WV, US

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.
• ProficientMicrosoftExcelskills,includingpivottables,graphing,and complexformulas.
• 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.
• Excellentoral,written,telephonicandinterpersonalskills,balancinganindependentandteam working environment.
• WorkingknowledgeofthePBMindustryandpharmacybenefitclaims.
• Experiencecreatingautomatedreports, self-servicetoolsandintegratingmultipledatainputs into a single dashboard (PowerBI).
• Skilledwithmathematicproblemsolvingandgraphing.
• Intermediatetoproficient skillsworkingwithSQLtoextractdata.
• PreviousexperienceworkinginPBMenvironment,healthplan,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.
• Interfacingwith,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(drugspends, 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.