Senior Pharmacy Compliance Reporting Analyst

Healthfirst; Town of Texas (WI); On-site; USD 138,000 - 155,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Life insurance

401k contributions

Incentive programs

Job summary

Healthfirst seeks a Senior Pharmacy Compliance Reporting Analyst to strengthen regulatory analytics and reporting across Pharmacy Operations. You will develop robust insights, automate reporting, and ensure MTM and communications comply with federal and state requirements.

The role requires extensive BI skills, data integrity focus, and collaboration with PBM and regulatory teams in a complex payer environment. NY-area posting with competitive benefits.

Qualifications

• 5 years of experience gathering, analyzing and communicating complex analytical business requirements to diverse audiences.
• 5 years of experience developing and utilizing reports and dashboards to analyze and measure performance of products.
• 5 years of experience using business intelligence/reporting tools, including Base SAS, SAS EG, Tableau, Aginity Workbench, SQL Server, and Management Studio.
• 5 years of experience managing multiple concurrent projects supporting Finance, Benefits, Utilization Management, Regulatory and Compliance, and Specialty Pharmacy.
• 5 years of experience writing scalable, maintainable, well-documented code adhering to 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/compliance strategies for Pharmacy Operations.
• Support the Director of Pharmacy Operations to ensure PBM and other vendors adhere to federal and state regulations.
• Run MTM member identification monthly and support MTM regulatory components and reporting.
• Ensure data integrity for day-to-day operations and develop program insights and analytic tools.
• Enhance and automate compliance reporting solutions including data collection, validation, aggregation, governance, and reporting.
• Develop analytics for risk detection, profiling, and mitigation; perform data analysis to solve complex issues.
• Identify enrollees for MTM monthly enrollment and support outreach data requests.
• Assist with monitoring approvals, rejections, and timely claims to detect errors.
• Oversee language/content/timeliness of enrollee/provider/pharmacy communications per regulatory expectations.
• Represent department for Transparency in Coverage Rule compliance.
• Participate in internal and external audits and deliver ad-hoc reporting to identify inefficiencies.

Skills

Regulatory compliance

Data analysis

Project management

Communication

Tools

Base SAS

SAS EG

Tableau

Aginity Workbench

SQL Server

Management Studio

Job description

Healthfirst believes that every New Yorker deserves access to the best available healthcare. As one of New York’s highest quality not-for-profit health insurers serving close to two million New Yorkers, we make this a reality for our members. Founded more than 30 years ago by the leading hospital systems in downstate New York, Healthfirst established a partnership model that enables hospitals, health systems, and physicians in our network to prioritize health outcomes over profits, placing the needs of our members and community first. Healthfirst serves members in New York City, on Long Island, and in Westchester, Rockland, Sullivan, and Orange counties, offering market-leading products to suit every life stage. Our offerings include Medicaid plans, Medicare Advantage plans, Child Health Plus plans, Essential Plans, Long-Term Care plans, and Qualified Health plans. We are currently posting for a Senior Pharmacy Compliance Reporting Analyst. Applicants must meet all minimum requirements to be considered.

Responsibilities

• Promote compliance by analyzing, identifying, and addressing risks to regulatory requirements.
• Collaborate with other departments to drive implementation, execution and monitoring of regulatory/compliance strategies and expectations for Pharmacy Operations.
• Support the Director of Pharmacy Operations to ensure the Pharmacy Benefit Manager (PBM) and other pharmacy delegated vendors adhere to federal and state regulations.
• Run the monthly identification of members for the Medication Therapy Management (MTM) program, support the regulatory components of MTM, and ensuring accurate and timely reporting to support outreaches and drive success in the measure.
• Ensure the integrity of the data used for day-to- day operations and develop program insights and analytic tools.
• Enhance and automate compliance reporting solutions, including data collection, validation, aggregation, governance, and reporting.
• Develop a robust analytical function for risk detection, profiling, and mitigation. Perform analysis of data to solve complex issues utilizing advanced statistical techniques and analysis.
• Develop process to identify and target enrollees for enrollment in the plan's medication therapy management program (MTM) on a monthly basis.
• Support additional data requests for MTM outreach as needed. Assist with the evaluation of monitoring approvals, rejections, and timeliness of claims to detect and correct errors.
• Perform oversight of language, content, and timeliness of enrollee/provider/pharmacy communications in accordance with regulatory expectations including, but not limited to, communications related to OIG/OMIG provider exclusion list, CMS preclusion list, formulary changes. Coordinate with internal stakeholders and PBM to accommodate non-binary gender identities.
• Represent the department to provide all requests and requirements to comply with Transparency in Coverage Rule.
• Participate in internal and external audit activities.
• Deliver ad-hoc reporting solutions to identify compliance and operational inefficiencies.

Minimum Requirements

• (1.) 5 years of experience gathering, analyzing and communicating complex analytical business requirements to diverse audiences, including technical and non-technical stakeholders across different teams and departments.
• (2.) 5 years of experience developing and utilizing reports and dashboards to analyze and measure performance of products, including translating data insights into actionable business strategies.
• (3.) 5 years of experience using business intelligence/reporting tools, including Base SAS, SAS EG, Tableau, Aginity Workbench, SQL Server, and Management Studio, to perform advanced statistical analysis, create interactive visualizations, manage databases, automate processes, and ensure data integrity.
• (4.) 5 years of experience managing multiple concurrent projects supporting various teams, including Finance, Benefits, Utilization Management, Regulatory and Compliance, and Specialty Pharmacy.
• (5.) 5 years of experience writing scalable, maintainable, well-documented, and supportable code, adhering to best practices to facilitate ongoing system support and enhancements.

Hiring Range*

• Greater New York City Area (NY, NJ, CT residents):

$137,583/year to $155,000/year

• All Other Locations (within approved locations):

$137,583/year to $155,000/year

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

• The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.