Medicare Data Lead Analyst, PBM Analytics and Reporting

PURPOSE: The Medicare Data Lead Analyst will be responsible for analyzing and interpreting healthcare data related to Medicare programs, specifically focusing on CMS Direct Subsidy, PDE, and MMR. The role involves working with large datasets, ensuring compliance with CMS regulations, and providing insights to improve healthcare outcomes and financial performance. They will work closely with other team members to collaborate and support team processes. They will partner with key business stakeholders to ensure end-to-end processes are built accurately and maintained.

KEY RESPONSIBILITIES:

• Analyze Medicare data, including PDE submissions, MMR reports, and CMS Direct Subsidy allocations
• Ensure data accuracy and compliance with CMS guidelines and reporting requirements
• Maintain and manage large datasets related to Medicare Part D and other relevant programs
• Monitor performance through tracking trends and identifying discrepancies in subsidy allocations and prescription drug events
• Work with cross-functional teams, including finance, IT, and healthcare professionals, to optimize Medicare data usage
• Lead process improvement through developing strategies to enhance data collection, reporting, and analysis efficiency
• Support ad-hoc and reoccurring work as needed
• Design, build, and maintain business intelligence reporting in collaboration with team leadership
• Continually focus on growing technical skills related to reporting tools and coding languages
• Partner with leadership and other key business contacts to ensure Medicare data and reporting knowledge is developed and maintained

QUALIFICATIONS:

• Highly creative and possess the ability to manage several projects concurrently
• Ability to prioritize effectively and to work efficiently
• Ability to work both autonomously and together as a team
• Highly organized and deadline driven
• Critical thinking and solution seeking
• Professional communication skills, both oral and written to all levels of an organization

KNOWLEDGE, EXPERIENCE, AND EDUCATION:

• Bachelor's Degree in related field, or equivalent experience
• 5+ years' experience in pharmacy benefit management, health insurance, or related industry
• Experience with Medicare Part D data, including PDE and MMR reporting
• Strong understanding of CMS regulations and healthcare analytics
• Intermediate to expert in SQL, SAS, R, Python, or other database languages
• Intermediate to expert in Power BI, Tableau, Qlik, or similar tool, preferred

COMPENTENCIES:

MANAGER Collaborates Building partnerships and working collaboratively with others to meet shared objectives. Manages Conflict Handling conflict situations effectively, with a minimum of noise. Courage Stepping up to address difficult issues, saying what needs to be said. Decision Quality Making good and timely decisions that keep the organization moving forward. Values Differences Recognizing the value that different perspectives and cultures bring to an organization. Directs Work Providing direction, delegating, and removing obstacles to get work done.

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