Senior Pharmacy Data Analyst
Job Summary
The Senior Pharmacy Data Analyst is a highly experienced professional who plays a critical role in advancing the strategic objectives of the Pharmacy Department. Reporting to the Manager of Pharmacy Contracting and Reporting, this role operates with a high degree of autonomy and precision, leveraging deep expertise in pharmacy data analytics to deliver timely, actionable insights that drive operational excellence, regulatory compliance, and member health outcomes.
Key Functions/Responsibilities
Develop and maintain a centralized dashboard for tracking pharmacy financial, operational, and clinical performance measures.
Lead the process of regulatory reporting from development, validation, and submission, collaborating with vendor partners to ensure data accuracy.
Conduct data queries to monitor performance metrics, including Medicare STAR measures and quality improvement initiatives.
Oversee PBM submission of all Part D claims to CMS as PDEs, identifying discrepancies and resolving errors to ensure 100% alignment.
Assume the leadership role of Pharmacy Data Steward, advising cross-functional departments on data exchange specifications and serving as the subject matter expert for pharmacy data integrity.
Support program processes by conducting User Acceptance Testing (UAT) and Quality Assurance (QA) testing.
Collaborate with Pharmacy Department team members to identify, prioritize, and analyze customer needs and requests to include the development and execution of sophisticated data-driven strategies that are closely aligned with the company's overarching mission and strategic objectives.
Communicate effectively with internal cross-functional areas regarding pharmacy programs, formulary management, and pharmacy processes.
Document workflows, perform analysis, and contribute to the design of systems to meet Pharmacy data needs.
Deliver compelling presentations of findings and insights to internal stakeholders, effectively communicating complex concepts in a clear, concise, and persuasive manner.
Architect and implement intricate data models, data flows, and data integration processes to ensure the accuracy, reliability, and efficiency of data collection, storage, and retrieval mechanisms.
Engage collaboratively with cross-functional teams, including business stakeholders, data scientists, and developers, to identify optimization opportunities and develop innovative, data-driven solutions.
Utilize leading BI tools such as Tableau or Power BI to create dynamic, visually compelling reports and distribute actionable insights effectively.
Harness advanced tools such as Excel (including VBA), Python, or R to manipulate, analyze, and visualize data with precision and sophistication.
Qualifications
Education Required: Bachelor's degree in mathematics, information management, information systems, statistics, or an equivalent combination of education, training, and experience.
Education Preferred: Master's degree preferred.
Experience Required: Minimum of 5 years of healthcare experience.
Experience Preferred/Desirable: Minimum of 10 years in health insurance or with a PBM; working knowledge of industry coding standards (e.g., generic product indicators, national drug codes, GPI’s, etc.); extensive experience analyzing pharmacy claims data, formulary utilization, and drug cost trends; familiarity with Medicare Part D data, STAR measures, and PDE submissions.
Supervision Received
General direction and supervision by Manager of Pharmacy Contracting and Reporting.
Compensation Range
$77,000 - $111,500
About WellSense
WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.