Job Description
Purpose:
They will be responsible for leading the analysis and reporting of pharmacy data for Medicare programs, 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 be responsible for leading our compliance reporting efforts and partner with key business stakeholders.
Key Responsibilities:
· Analyze Medicare data, including PDE submissions, MMR reports, and CMS Direct Subsidy allocations
· Work with Finance and Account Management to project yearly Medicare changes
· Ensure data accuracy and compliance with CMS guidelines and reporting requirements
· Own and maintain reporting processes needed to support organization compliance 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, Account Management, and Compliance to optimize Medicare data usage
· Lead process improvement through developing strategies to enhance data collection, reporting, and analysis efficiency
· 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
· Support ad-hoc and reoccurring work as needed
We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.
Required Skills & Experience
Experience:
• 7+ years in pharmacy benefit management (PBM), health insurance, or similar field
• Experience with Medicare Part D data (PDE, MMR)
• Knowledge of CMS regulations and healthcare analytics
• Skilled in SQL, SAS, R, Python (or similar)
• Bachelor’s degree or equivalent experience
Nice to Have Skills & Experience
Experienced with Power BI, Tableau, Qlik
Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.