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Mfx145702hn67z7ngrv

Senior Data Analyst, Pharmacy

EmblemHealth New York Full-Time
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Work effectively with leaders of Pharmacy and other Departments to learn and understand stated goals, develop reports and provide analytics support to accomplish them.  Interpret and utilize data and information to develop and provide recommendations for process improvements.  Establish strong relationships within the company to leverage necessary subject matter expertise to reach solutions.  Strive for innovative data analytics solutions; work with PBM to ensure accurate and effective reporting support. 

Responsibilities:

  • Generate complex data analytics projects using both Pharmacy and Medical data
    • Meet with internal and external business partners to determine the objectives and specifics of each project and create project plans
    • Create SAS code for each project to ensure efficient and repeatable reporting
    • Set milestones to ensure the projects are on track
    • Review each SAS log to ensure accuracy and document results, then obtain sign-off from immediate supervisor
    • Communicate clearly the details of the projects to the supervisor and the leadership
    • Maintain project dashboard and provide weekly updates to immediate supervisor
  • Complete the data analytics projects efficiently. Determine if a request will be a one-time or a recurring project. If it is a recurring project, create a process to easily replicate  
  • Pursue innovative data analytics solutions, using advanced tools and predictive analytics
  • Follow the changes in the Health Care Industry closely and contribute to EmblemHealth turnaround
  • Collaborate on complex special projects to support department with flexibility, for example Formulary Cost Analysis and Medical Utilization Management cost analysis
  • Utilization Management (UM) Reporting
    • Maintain a process of daily, weekly, monthly and quarterly reporting
    • Interact with UM vendor for streamlined reporting solutions
    • Collaborate with CMS auditors on Program Audits, Timeliness Monitoring and various other types of audits
    • Create reports for NCQA accreditation project. Report the results to Pharmacy leadership to monitor timeliness of coverage determination reviews
  • Handle the Annual Health Plan Management System (HPMS) Data Submission
    • Develop quarterly review process
    • Establish strong QA process for accurate reporting
  • Assist management on special projects
  • Support New Plan Year implementation testing 
  • Support CMS audits
  • Support financial statement audits
  • Provide support to cascaded projects and goals
  • Regulatory Reporting
    • Medicaid Managed Care Operating Report
    • Special Investigation Unit reports
    • Retiree Drug Subsidy Reports for USA, NYSHIP, MTA
  • Other reports
    • OMT
    • Upload and analyze cash receipt rebate files from ESI
    • STARS and PPA reports
    • ALPHA GH3, NonGH3, CCI Medicare, CCI HIX/Commercial table creation and maintenance
    • Inpharmative data analysis and manipulation until vendor is sunset
  • Various Ad Hoc Reports
  • Other activities, including creating guides and training new team members
Qualifications:

  • Bachelor’s degree in Business, Finance, Health Administration, Math, Sciences, IT or related; Master’s preferred
  • Minimum of four (4) to six (6) years’ experience in data analytics required
  • Related experience in a PBM or Managed Healthcare setting preferred
  • Strong expertise with MS Office tools (including Access and Excel) required
  • Programming experience or working knowledge of SAS or Oracle/SQL queries required
  • Effective communication (verbal, written, presentation) skills required
  • Experience working with Medicare Part D preferred
  • Reporting/Business Intelligence experience required
  • Understanding of financial concepts, claims processing concepts and knowledge of healthcare operating systems required

Recommended skills

Medicaid Managed Care
Medicare
Medicare Part D
Data Analysis
Process Improvements (Business)
Claims
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EmblemHealth is
a local, neighborhood health plan that has served the New York City area and
surrounding communities for more than 75 years. That’s the kind of experience
that makes us unique. We’re proud to be one of the nation’s largest
not-for-profit health plans, serving 3.1 million people who live and work
across the New York tristate area.

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