Pharmacy Analyst

Catholic Health•Centereach, NY

About The Position

The Pharmacy Analyst reviews and processes medication prior authorization requests from healthcare providers, patients, and insurance companies, coordinating communications and documentation to support timely, accurate prescription approvals. The role follows up on pending or denied requests, assists patients with the authorization process, and supports medication therapy management when applicable. It also supports compliance with the 340B Drug Pricing Program by analyzing program data, verifying that program requirements are implemented correctly, conducting audits and reconciliations, preparing reports, and assisting with enrollment and regulatory compliance activities. The analyst collaborates with pharmacy, finance, compliance, legal, healthcare staff, and external vendors, and helps develop procedures, prepare for audits, and provide training on 340B requirements. Catholic Health is a Long Island health and human services organization with more than 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice, and a network of physician practices. Its stated focus is compassionate, collaborative, evidence-based care for the community.

Requirements

High school diploma or equivalent.
At least 2–3 years of experience in a pharmacy setting; prior authorization or insurance verification experience is preferred.
Pharmacy Technician Certification (CPhT) is required or must be obtained within a timeframe not specified in the posting.
Strong attention to detail and organizational skills.
Excellent written and verbal communication skills.
Ability to work independently and as part of a team, manage multiple tasks, and work in a fast-paced environment.
Proficiency with pharmacy management software and Microsoft Office Suite.
Strong customer service orientation and problem-solving abilities.
Strong understanding of 340B Drug Pricing Program regulations and guidelines.
Excellent analytical skills, including the ability to interpret complex data.
Proficiency in Microsoft Excel, data analysis tools, and pharmacy management systems.
Strong organizational and project management skills.

Nice To Haves

Pharmacy Technician Certification (CPhT) is preferred in the education section, although the certifications section also states it is required or must be obtained within an unspecified timeframe.
Knowledge of insurance processes, formulary requirements, and prior authorization procedures.
Experience with 340B program management, auditing, or reporting.
340B certification or willingness to obtain it.

Responsibilities

Review, validate, and process medication prior authorization requests based on patients’ insurance coverage.
Contact physicians and other healthcare professionals to obtain additional documentation or clarification for authorization requests.
Communicate with insurance providers to track request status and resolve delays or other issues.
Maintain accurate records of authorization requests, approvals, denials, and outcomes for compliance and reporting.
Help patients understand the authorization process, required steps, and the status of their requests.
Monitor pending requests and follow up on outstanding approvals or denials to support timely resolution.
Ensure authorization processes comply with company policies, healthcare regulations, and insurance requirements.
Support medication therapy management programs when applicable.
Review and analyze 340B program activities for compliance with applicable federal, state, and institutional requirements and policies.
Collect, analyze, and interpret drug purchasing, inventory, and dispensing data and prepare 340B reports.
Audit 340B transactions, compare purchased and dispensed drugs, verify documentation and compliance, reconcile discrepancies, and take corrective action when needed.
Support initial and ongoing 340B program enrollment, including submitting documentation and assisting with federal regulator audits.
Assist in developing and implementing 340B policies and procedures.
Coordinate 340B activities with pharmacy, finance, legal, compliance, and external vendors.
Provide training and guidance to pharmacy and other healthcare staff on 340B compliance and best practices.
Prepare accurate, complete documentation for internal and external audits.
Investigate and resolve issues involving 340B inventory management, purchases, or reporting, documenting corrective actions.
Stay informed about changes in 340B legislation, policies, and best practices.