Pharmacy Analyst I

SCAN Health Insurance

8d•$25 - $37•Remote

About The Position

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.

Requirements

0-3 years of related experience.
High School Diploma or equivalent experience required.
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.

Nice To Haves

Bachelor's Degree or equivalent experience preferred.
Familiarity with Tableau and Visio.

Responsibilities

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.

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!