Pharmacy Reporting Analyst

It's an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary:
Reporting to the Manager of Pharmacy Contracting and Reporting, the Pharmacy Reporting Analyst works autonomously to apply analytical expertise and deliver a comprehensive analysis of pharmacy data, encompassing key performance indicators, member demographics, drug utilization, and other relevant metrics. This role is pivotal in providing actionable insights to support strategic decision-making within the Pharmacy Department using effective communication to drive positive outcomes for the organization. The incumbent will have exceptional analytical acumen, a mastery of SAS and SQL, a command of the Microsoft suite, enabling seamless data processing and dynamic presentation of insights. As a Pharmacy Report Analyst, this role embodies the highest level of proficiency in analyzing complex pharmacy data, providing strategic insights, and driving actionable recommendations to optimize pharmacy operations, support data-driven cost-effective benefit management and enhance member outcomes.

Our Investment in You:

* Full-time remote work

* Competitive salaries

* Excellent benefits

Key Functions/Responsibilities:

* Develop and maintain a centralized dashboard for tracking pharmacy financial, operational, and clinical performance measures.

* Lead the process of regulatory reporting from development, validation, and submission collaborating with vendor partners to ensure data accuracy.

* Conduct data queries to monitor performance metrics, including Medicare STAR measures and quality improvement initiatives.

* Oversee PBM submission of all Part D claims to CMS as PDEs, identifying discrepancies and resolving errors to ensure 100% alignment.

* Assume the leadership role of Pharmacy Data Steward, advising cross-functional departments on data exchange specifications and serving as the subject matter expert for pharmacy data integrity.

* Support program processes by conducting User Acceptance Testing (UAT) and Quality Assurance (QA) testing.

* Collaborate with Pharmacy Department team members to identify, prioritize, and analyze customer needs and requests to include the development and execution of sophisticated data-driven strategies that are closely aligned with the company's overarching mission and strategic objectives

* Communicate effectively with internal cross-functional areas regarding pharmacy programs, formulary management, and pharmacy processes.

* Document workflows, perform analysis, and contribute to the design of systems to meet Pharmacy data needs.

* Deliver compelling presentations of findings and insights to internal stakeholders, effectively communicating complex concepts in a clear, concise, and persuasive manner using Utilize leading BI tools such as Tableau or Power BI.

* Architect and implement intricate data models, data flows, and data integration processes to ensure the accuracy, reliability, and efficiency of data collection, storage, and retrieval mechanisms.

* Engage collaboratively with cross-functional teams, including business stakeholders, data scientists, and developers, to identify optimization opportunities and develop innovative, data-driven solutions.

* Utilize leading BI tools such as Tableau or Power BI to create dynamic, visually compelling reports and distribute actionable insights effectively.

* Harness advanced tools such as Excel (including VBA), Python, or R to manipulate, analyze, and visualize data with precision and sophistication.

* Other duties as assigned

Supervision Exercised:

• No supervision exercised.

Supervision Received:

• General direction and supervision from Manager of Pharmacy Contracting and Reporting

Qualifications:

Education Required:

• Bachelor's degree in mathematics, information management, information systems, statistics, or an equivalent combination of related education, training, and experience.

Education Preferred:

• Master's degree preferred.

Experience Required:

• Minimum of 5 years of healthcare experience.
• Working knowledge of industry coding standards (e.g., generic product indicators, national drug codes, GPI's, etc.).

Experience Preferred/Desirable:

• 5+ years of prior managed care experience, particularly with Medicaid/Medicare Managed Care/Part D.
• Experience with pharmacy benefit managers (PBMs) or direct pharmacy experience.

Required Licensure, Certification or Conditions of Employment:

• Successful completion of pre-employment background check

Competencies, Skills, and Attributes:

• Excellent oral and written communication skills, with the ability to engage with all levels of the organization and external contacts.
• Proficiency in Microsoft Office applications, particularly MS Outlook, MS Word, and MS Excel, along with proficiency in other data processing applications.
• Intermediate level of proficiency in SQL programming language.
• Firm understanding of IT business processes and the ability to articulate business requirements.
• Demonstrated leadership and consultative skills in engaging with key business partners.
• Strong analytical and clinical problem-solving skills.
• Proficient in queries, report writing, and presentation of findings.
• Aptitude for quickly learning new systems and databases.
• Ability to organize, synthesize, and analyze large volumes of information.
• Capable of managing multiple projects and delivering high-quality products within established timelines.
• Detail-oriented with a commitment to producing analytic products of the highest accuracy.
• Excellent interpersonal skills and the ability to thrive in a team-oriented environment.

Working Conditions and Physical Effort:

• Regular and reliable attendance is an essential function of the position.
• Work is normally performed in a typical remote, home-office environment.
• No or very limited physical effort required. No or very limited exposure to physical risk.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees