PHARMACY DATA AND REPORTING ANALYST

About the role

The Pharmacy Data and Reporting Analyst plays a key role in supporting the Pharmacy department by collecting, analyzing, and reporting on pharmacy claims and clinical program data. The position is responsible for developing and maintaining recurring and ad hoc reports, monitoring drug utilization and cost trends, and supporting compliance with CMS Part D, NYSDOH, and OMIG reporting requirements. This role requires strong data analytics skills, a working knowledge of pharmacy benefit management (PBM) data, and the ability to translate complex data sets into actionable insights that support clinical, financial, and regulatory decision-making.

Responsibilities

• Extract, compile, and analyze pharmacy claims data from the Pharmacy Benefit Manager (PBM) and internal data warehouse systems to support departmental reporting and monitoring needs.
• Develop, maintain, and distribute recurring and ad hoc reports, dashboards, and pivot table analyses (e.g., drug spend trends, high-utilizer caseloads, therapeutic class and HICL/GPI-level utilization) using Excel, SQL.
• Prepare monthly and quarterly utilization, cost, and trend reports to support pharmacy leadership, clinical programs (e.g., palliative care, homebound, high-risk/high-impact reviews), and interdepartmental stakeholders.
• Validate data quality and integrity across pharmacy claims platforms, the Enterprise Data Warehouse (EDW), and clinical documentation systems, identifying and resolving discrepancies.
• Support timely and accurate completion of CMS Part D reporting requirements, including enrollment/disenrollment, Medication Therapy Management (MTM), grievances, coverage determinations/redeterminations/reopenings, and Drug Utilization Review (DUR) controls.
• Assist in the administration of the Drug Management Program (DMP) by compiling OMS/MARx data, tracking At-Risk and Potentially At-Risk Participant (ARB/PARB) case management timelines, and preparing required notices and supporting documentation.
• Collect and prepare pharmacy-related data for NYSDOH, OMIG, and CMS inquiries, audits, and submissions, ensuring accuracy, completeness, and compliance with regulatory deadlines.
• Support formulary transition activities and manufacturer discount program workflows, including tracking and reporting on rebate and discount data accuracy.
• Monitor and report on Star Ratings and Part D quality measures (e.g., medication adherence, medication safety) to support performance improvement initiatives.
• Lead the analysis, validation, monitoring, and reporting of Medicare Part D Prescription Drug Event (PDE) data submitted through the CMS Drug Data Processing System (DDPS).
• Support data quality initiatives, regulatory compliance, encounter data integrity, operational reporting, and stakeholder engagement to ensure accurate processing and submission of Part D pharmacy claims data.
• Assist management with timely and accurate responses to internal and external audit inquiries, including those from government agencies (OMIG, CMS, DOH).
• Investigate discrepancies or anomalies in pharmacy claims and reporting data, conduct root cause analysis, and recommend process improvements to enhance accuracy and efficiency.
• Maintain clear documentation of 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 build sustainable reporting solutions.
• Maintain a high level of customer service for internal and external stakeholders, addressing data and reporting inquiries promptly and professionally.

Qualifications

• Bachelor’s degree required.
• Certified Professional Coder a plus.
• 3–5 years of healthcare experience in a managed care setting required.
• Proficiency in data analytics, i.e., SAS, SQL required.
• Claims adjudication and understanding of claims PPS strongly preferred.
• Knowledge of Medicaid and Medicare benefits, enrollment and billing, and provider contracting required.
• Knowledge of CPTs, ICD-9/ICD-10, HCPC, DRG, Revenue, RBRVS.
• Proficiency in MS Excel, Word, PowerPoint, and experience using a claims processing system or comparable database software.
• Effective oral, written, and interpersonal communication skills required.
• Able to multitask efficiently, effectively, and timely.
• Strong organizational skills and work ethic.
• Detail-oriented, professional, and collaborative; a great team player.

Physical Requirements

• Standing up to 6 hours a day.
• Sitting/stationary positions up to 6–8 hours a day for consecutive periods.
• Lifting/push/pull up to 50 pounds using OSHA guidelines.
• Bending/squatting to perform essential functions.
• Safe maneuvering of stairs, steps, walking, and climbing to access work areas.
• Agility and fine motor skills to operate equipment, devices, instruments, and tools (e.g., typing, use of supplies).
• Visual ability to read documentation, papers, orders, signs, and type/write with accuracy.
• Audio hearing and motor skills to listen, document, and speak clearly and accurately.
• Cognitive ability to demonstrate good decision-making, reasoning, and analysis.

Pay

$85,000 – $90,000 (2–5 years of experience)
$90,000 – $95,000 (5+ years of experience)