PBM Regulatory Reporting Coordinator

AnewHealth is one of the nation’s leading pharmacy care management companies specializing 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.

About the role

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. 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 (an AnewHealthRx company) is a Pharmacy Benefits Manager (PBM) for commercial plans, Medicare Part D Plans, and PACE Plans.

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 and provide 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.
• Prepare Pharmastar claim audit results and disseminate a summary of the results to clients.
• Deployment activities related to separation of duties.
• Other related duties as assigned.

Requirements

• Associate’s degree preferred. High School Diploma or equivalent required.
• 1+ years of audit/quality and PACE industry experience.
• 2 years of Healthcare industry experience (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.
• Current on plan and benefit structures and Medicare guidelines.
• Proficiency in Microsoft Excel required.
• A strong understanding of TOAD, SSRS, or T-SQL a plus.

Skills

• Attention to detail and accuracy is critical.
• Ability to identify and resolve issues.
• Knowledge of government healthcare programs.
• 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.

Schedule

This is a full-time position with an expectation to work an average of 40 hours per week, and an ability to be available outside of normal business hours to meet customer expectations on an ad-hoc basis.

Physical Demands & Requirements

• Communicates by way of the telephone or computer with providers, participants, customers, and vendors.
• Operates a computer and other office productivity machinery, such as a calculator, copy machine, fax machine, and office printer.
• Remains stationary for extended periods of time (i.e., sitting on a continuous basis).
• Occasionally exerts up to 20 pounds of force to lift, carry, push, pull, or move objects.
• Visual acuity to perform activities such as identifying, inputting, and analyzing data on a computer terminal and/or in hard copy.
• Occasional standing, walking, climbing stairs, and reaching to retrieve shelved items.
• Occasional bending/stooping.

Work Environment

• This job is a remote working position, and adherence to the AnewHealthRx remote worker policies is mandatory.
• Moderate pressure to meet scheduled appointments and deadlines.

Benefits

• Comprehensive benefit package for full-time employees, including medical/dental/vision, flexible spending, company-paid life insurance, and short-term disability as well as voluntary benefits.
• 401(k) plan.
• Paid Time Off and paid holidays.
• Medical, dental, and vision coverage effective the 1st of the month following the date of hire.