PHARMACY DATA AND REPORTING ANALYST

C2Q Health Solutions•New York, NY

5d•$85,000 - $95,000

About The Position

The Pharmacy Data and Reporting Analyst supports the Pharmacy department by collecting, analyzing, and reporting pharmacy claims and clinical program data. The role develops and maintains recurring and ad hoc reports, monitors drug utilization and cost trends, and supports compliance with CMS Part D, NYSDOH, and OMIG reporting requirements. It requires strong data analytics skills, working knowledge of PBM data, and the ability to translate complex data into insights that support clinical, financial, and regulatory decisions. The analyst extracts, compiles, validates, and analyzes data from PBM, internal data warehouse, and clinical documentation systems. The position prepares utilization, cost, trend, quality, and regulatory reporting; supports audits and compliance submissions; investigates data discrepancies; and collaborates with Clinical Pharmacy, Compliance, Quality, IT, and other stakeholders on sustainable reporting solutions. The schedule is 8:30 AM–5:30 PM, 40 hours per week. Physical requirements include standing for up to six hours daily; sitting for six to eight hours, including consecutive periods; lifting, pushing, or pulling up to 50 pounds; bending, squatting, and safely navigating stairs and work areas; using fine motor skills and equipment; reading and producing written documentation; listening and speaking clearly; and applying sound judgment, reasoning, and analysis.

Requirements

Bachelor's degree required.
Three to five years of healthcare experience in a managed care setting required.
Proficiency in data analytics, including SAS and SQL, required.
Knowledge of Medicaid and Medicare benefits, enrollment and billing, and provider contracting required.
Proficiency in MS Excel, Word, and PowerPoint, and experience using a claims processing system or comparable database software.
Effective oral, written, and interpersonal communication skills.
Ability to multitask efficiently, effectively, and timely.
Strong organizational skills and work ethic.
Detail-oriented, professional, collaborative, and able to work as part of a team.
Ability to meet the stated physical requirements, including standing, sitting, lifting or pushing or pulling up to 50 pounds, bending, squatting, navigating stairs and work areas, using fine motor skills and equipment, reading and producing documentation, listening and speaking clearly, and applying cognitive and analytical skills.

Nice To Haves

Certified Professional Coder certification.
Claims adjudication experience and understanding of claims PPS are strongly preferred.
Knowledge of CPT, ICD-9/ICD-10, HCPC, DRG, Revenue, and RBRVS.

Responsibilities

Extract, compile, and analyze pharmacy claims data from PBM and internal data warehouse systems.
Develop, maintain, and distribute recurring and ad hoc reports, dashboards, and pivot table analyses using Excel and SQL.
Prepare monthly and quarterly utilization, cost, and trend reports for pharmacy leadership, clinical programs, and interdepartmental stakeholders.
Validate data quality and integrity across pharmacy claims platforms, the Enterprise Data Warehouse, and clinical documentation systems, and identify and resolve discrepancies.
Support CMS Part D reporting requirements, including enrollment and disenrollment, MTM, grievances, coverage determinations, redeterminations and reopenings, and DUR controls.
Support Drug Management Program administration by compiling OMS/MARx data, tracking ARB/PARB case-management timelines, and preparing notices and supporting documentation.
Collect and prepare pharmacy-related data for NYSDOH, OMIG, and CMS inquiries, audits, and submissions.
Support formulary transition activities and manufacturer discount program workflows, including tracking and reporting rebate and discount data accuracy.
Monitor and report on Star Ratings and Part D quality measures, including medication adherence and medication safety.
Lead analysis, validation, monitoring, and reporting of Medicare Part D PDE data submitted through the CMS DDPS.
Support data quality initiatives, regulatory compliance, encounter data integrity, operational reporting, and stakeholder engagement related to Part D pharmacy claims data.
Assist management with responses to internal and external audit inquiries, including inquiries from OMIG, CMS, and DOH.
Investigate discrepancies or anomalies in pharmacy claims and reporting data, conduct root-cause analysis, and recommend process improvements.
Document data collection methods, reporting processes, and workflows to support audit readiness and knowledge continuity.
Collaborate with Clinical Pharmacy, Compliance, Quality, and IT teams to identify reporting needs, refine data extracts, and develop sustainable reporting solutions.
Address data and reporting inquiries promptly and professionally for internal and external stakeholders.
Perform other duties as assigned.