Pharmacy Data Analyst

The Health Plan (THP); Wheeling (WV); On-site; USD 65,000 - 90,000; Full time

Job summary

The Health Plan is seeking a Pharmacy Data Analyst to improve operations by analyzing data from sources like Express Scripts and Ipro, extracting trends, and delivering insights for commercial, exchange, Medicaid, and Medicare lines. Role includes support for benefit management and coding within the pharmacy benefit adjudication platform.

Responsibilities include integrating data across sources, preparing analyses for management, and ensuring data quality to guide improvements.

Qualifications

• Bachelor’s or master’s degree related to data analytics.
• Experience in data collection, analysis, and visualization methods.
• Proficiency with Excel pivot tables, graphs, and formulas.
• Working knowledge of quality improvement principles, study design and statistical modeling.

Responsibilities

• Integrate data from multiple sources to produce data elements supporting continuous quality improvement.
• Assist pharmacy team with complex data needed for projects.
• Interpret and analyze data quality and collection processes; provide recommendations.
• Identify data quality issues and work with partners to resolve them.
• Develop new data information processes and tools; improve reporting processes.
• Prepare data for presentations to management and committees; tailor to internal/external audiences.
• Assist in defining and delivering report deliverables to meet requirements.
• Reconcile daily PBM eligibility data with PBM reporting and ensure alignment with measures.
• Understand client drug price guarantees, admin fees, rebates, and related terms.
• Review PBM data files for compliance and assist in report development and testing.

Skills

Excel

PowerBI

SQL

Data analysis

Teamwork

Multi-tasking

Education

Bachelor's degree in data analytics

Master's degree in data analytics

Tools

PBM platform

Data mapping tool

Job description

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

• Must possess a bachelor’s or master’s degree related to data analytics or at least one year experience in pharmacy and medical claim data reporting.
• Proficient Microsoft Excel skills, including pivot tables, graphing, and complex formulas.
• Experience in data collection, analysis, and visualization methods.
• Must possess a working knowledge of quality improvement principles, theory, study design and statistical modeling.
• Flexible and able to multi-task, work in a fast-paced environment and adapt to changing processes.
• Self-motivated and goal oriented.
• Ability to work effectively as part of a team and independently.
• 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.

Desired

• Excellent oral, written, telephonic and interpersonal skills, balancing an independent and team working environment.
• Working knowledge of the PBM industry and pharmacy benefit claims.
• Certified Pharmacy Technician (CPhT)
• Experience creating automated reports, self-service tools and integrating multiple data inputs into a single dashboard (PowerBI).
• Skilled with mathematic problem solving and graphing.
• Intermediate to proficient skills working with SQL to extract data.
• Previous experience working in PBM environment, health plan, or managed 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, and provide recommendations regarding data accuracy and data collection needs and processes.
• Research and identify data quality issues and work with internal and external partners to create a resolution.
• Work with business unit(s) to identify opportunities to enhance existing processes and to develop new data information processes and tools. Continuously assess and improve data collection and reporting processes.
• Interfacing with, gathering information from, and preparing data for presentations to various levels of management, committees, internal and external.
• Work with designated department to assess, define, and develop report deliverables to meet internal and customer requirements.
• Reconcile daily eligibility file report with PBM and ensure that the eligibility reporting procedure aligns with HEDIS measures.
• Understand and calculate client drug price guarantees, admin fees, rebates and other terms related to pharmacy client and vendor contracts.
• Review files received for PBM compliance with data needs, assist with the development of reports, testing files and configuring data in mapping tool.
• Create and maintain the pharmacy executive management funds dashboard (drug spends, rebates, savings, PMF, etc.)
• Assist with auditing the PBM plan benefit coding and plan materials to ensure pharmacy benefits reflect the intent and/or client expectations.
• Assist in submitting and updating benefit material for internal and external teams, such as customer service applications.
• Assist with creating and recording impact reports from internal audit findings and work with PBM for solutions via corrective action plan.

8:00am - 5:00pm
40 hours