PBM Regulatory Reporting Analyst

AnewHealth•WI - Remote, WI

1d•Remote

About The Position

AnewHealth is one of the nation’s leading pharmacy care management companies that specializes in caring for people with the most complex, chronic needs—wherever they call home. We enable better outcomes for patients and the healthcare organizations who support them. Established in 2023 through the combination of ExactCare and Tabula Rasa HealthCare, we provide a suite of solutions that includes comprehensive pharmacy services; full-service pharmacy benefit management; and specialized support services for Program of All-Inclusive Care for the Elderly. With over 1,400 team members, we care for more than 100,000 people across all 50 states. The Regulatory Reporting Analyst is responsible for working closely with each of the Pharmastar teams to assist with Pharmastar’s adherence to both internal and regulatory procedures, ensure proper documentation, provide reporting activities, and disseminate applicable information to clients. The Regulatory Reporting Analyst will work under the supervision of the Sr Director of Data Strategy. This position also assists with various internal tasks that ensure a high level of overall client satisfaction. On the job training will be provided. Pharmastar (a AnewHealthRx company) is a Pharmacy Benefits Manager (PBM) for commercial plans, Medicare Part D Plans and PACE Plans.

Requirements

High School Diploma or equivalent required.
1+ years of audit/quality and PACE industry experience.
2 years of Healthcare industry experience, required.
Current on plan and benefit structures and Medicare guidelines.
Proficiency in Microsoft Excel required.
Attention to detail and accuracy is critical.
Ability to identify and resolve issues.
Knowledge of government health care program.
Knowledge of pharmacology and pharmacological terms.
Excellent verbal and written communication skills and professionalism when working with clients.
Ability to provide tactful responses under stressful situations and conditions.
Detail oriented with strong analytical and research skills.
Ability to multi-task and prioritize projects.
Able to maintain the highest standard of confidentiality.
Ability to work well with many different personality types.
Strong customer focus.
Strong computer skills including using word processors, spreadsheets, and database software.

Nice To Haves

Associate’s degree preferred.
Health plan or insurance experience, a plus.
PBM experience preferred.
CPhT (Certified Pharmacy Technician) certification, a plus.
Experience in a pharmacy support role, a plus.
A strong understanding of TOAD, SSRS, or T-SQL, a plus.

Responsibilities

Assist with compiling Quarterly Pharmastar Compliance reports.
Assist with preparation and analysis of PDE, PDE Rejections, FIR reports, and plan rebate reports.
Assist with PACE Bid preparation, including working with external auditors
Assist with weekly Financial Billing, plan admin fees, pharmacy network payment review reporting and activities
Handle Action Required reporting, associated member authorizations and related activity
Create NDPDP Pharmacy Encounter data file preparation, testing and submission, and error review.
Assist with QA of existing reports and adjudication results.
Review report output for issues for proactive recommendations for change
Respond to internal ticketing system requests and inquiries
Generate reports to meet clients’ needs and internal support needs and make updates where appropriate.
Ensure that HIPAA guidelines are followed in every communication with clients.
Stay current on plan and benefit structures, pharmacological updates, and Medicare Part D guidelines.
Attend department and company meetings and educational programs upon request.
Other related duties as assigned. (assist Prepare Pharmastar claim audit results and disseminate to clients a summary of the results)
Deployment activities related to separation of duties.