Pharmacy Data Analyst

The Health Plan Of West Virginia Inc; Wheeling (WV); On-site; USD 65,000 - 85,000; Full time

Job summary

The Health Plan Of West Virginia Inc. is seeking a Pharmacy Data Analyst in Wheeling, WV to optimize Pharmacy Services by analyzing data from multiple sources and extracting trends to improve health and financial outcomes.

The role supports plan benefit management and coding across Commercial, Exchange, Medicaid, and Medicare within the pharmacy benefit adjudication platform; strong Excel, SQL, and Power BI skills are essential.

Qualifications

• Bachelor’s or master’s degree related to data analytics or at least one year in pharmacy/medical claim reporting.
• Proficient Excel skills including pivot tables and complex formulas.
• Experience in data collection, analysis, and visualization.
• Knowledge of quality improvement principles, theory, study design and statistical modeling.
• Able to multi-task in a fast-paced environment and adapt to changing processes.
• Strong teamwork and independent work abilities.

Responsibilities

• Integrate data from multiple sources to produce data elements supporting quality improvement.
• Assist pharmacy team with complex data-driven projects.
• Interpret and provide recommendations on data accuracy and collection needs.
• Identify data quality issues and collaborate with partners to resolve them.
• Develop new data information processes and tools to meet requirements.
• Prepare data for presentation to management and committees.

Skills

Data analytics

Excel & formulas

Power BI

SQL queries

Data visualization

Statistical modeling

Communication

Education

Bachelor's or master's in data analytics or related field

1+ year experience in pharmacy data reporting

Tools

Power BI

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

3 days ago Requisition ID: 1611

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.