[Hiring] Pharmacy Analyst I @SCAN Health Insurance

Role Description

The Pharmacy Analyst I supports daily operational functions and oversight of the SCAN Pharmacy Benefit Management (PBM) company on delegated Part D activities. This role assists with maintaining compliance with Part D deadlines and regulatory timeframes. Under guidance, the Analyst I provides support in managing Eligibility files, Prescription Drug Event (PDE) data, Drug Plan Finder submissions, Financial Information Reporting, and other key functions to help ensure adherence to Medicare requirements.

• Serve as a subject matter expert for Part D Reporting requirements, Pharmacy Access Requirements, Prescription Drug Event data, Financial Information Reporting and Drug Plan Finder files by keeping up to date with Medicare requirements.
• Ensure eligibility and coordination of benefit files are sent to the PBM for processing and assess if file enhancements are needed.
• Ensure the PBM is processing Prescription Drug Events, Automated Claims Reprocessing and Financial Information Data according to CMS regulatory standards by conducting daily oversight.
• Ensure PBM oversight of claims adjudication and retrolics and ensure 1/1 Readiness related to eligibility.
• Analyze and monitor large data sets that are exchanged from SCAN to the PBM using a variety of reporting tools.
• Ensure audit documentation is prepared according to audit instructions and provided within the specified audit time frame.
• Prepare written responses or documentation for pharmacy audits.
• Perform routine monitoring to ensure Part D compliance and detect performance issues or operational gaps.
• Assist in the implementation, testing, and validation of pharmacy benefits to ensure accurate benefit configuration and claims adjudication.
• Collaborate with cross-functional teams, including Compliance, Product, and IT, to address issues and support PDE and other pharmacy initiatives.
• Identify and escalate issues related to pharmacy benefits, claims processing, and PDE submissions, working with the PBM and internal teams to resolve discrepancies.
• Maintain professional and technical knowledge by attending educational workshops; reviewing professional publications & CMS regulatory requirements; establishing personal networks; participating in professional societies.
• Contribute to the development, maintenance, and documentation of standard operating procedures (SOPs) and desktop procedures to support compliance and operational efficiency.
• Actively support the achievement of SCAN’s Vision and Goals.
• Other duties as assigned.

Qualifications

• 0-3 years of related experience.
• High School Diploma or equivalent experience required.
• Bachelor's Degree or equivalent experience preferred.
• Expert knowledge of CMS Part D regulations e.g., CMS Call Letters, MA-PD application, PDE, LICS, Claims Processing, Part D Reports, FIR.
• Knowledge of PDE calculations that pertain to Enhance Alternative Plans, Coverage Gap, etc.
• Ability to prioritize workload to meet deadlines.
• Ability to multi-task in a fast pace environment.
• Ability to interact effectively and professionally with all levels of staff.
• Excellent grammar and writing skills.
• Excellent verbal skill sets to be able to communicate in conference calls and in large meetings.
• Team player with a strong work ethic.
• Self-starter that can take the lead on a project and manage its progress for completion.
• Detail oriented and is able to work with large data sets.
• Advanced skills with Microsoft Office (e.g., Word, Excel, Access, Outlook, and PowerPoint) and SQL.
• Familiarity with Tableau and Visio.

Benefits

• Base salary range: $25.38 to $36.76 per hour.
• Internal title: Pharmacy Analyst I.
• Work Mode: Remote.
• An annual employee bonus program.
• Robust Wellness Program.
• Generous paid-time-off (PTO).
• 11 paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday.
• Excellent 401(k) Retirement Saving Plan with employer match and contribution.
• Robust employee recognition program.
• Tuition reimbursement.
• An opportunity to become part of a team that makes a difference to our members and our community every day!