PBM Director of Medicare Data Analytics - AmWINS : Job Details

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The Director of Medicare and Compliance Data will be responsible for analyzing and interpreting pharmacy 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 be responsible for leading compliance reporting efforts and partnering with key business stakeholders.

• 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 for organization compliance.
• Maintain and manage large datasets related to Medicare Part D and other programs.
• Monitor performance by tracking trends and identifying discrepancies in subsidy allocations and prescription drug events.
• Collaborate with cross-functional teams to optimize Medicare data usage.
• Lead process improvements to enhance data collection, reporting, and analysis efficiency.
• Design, build, and maintain BI reporting in collaboration with leadership.
• Focus on growing technical skills related to reporting tools and coding languages.
• Partner with leadership to develop and maintain Medicare data and reporting knowledge.
• Support ad-hoc and recurring work as needed.

• Highly creative with the ability to manage multiple projects concurrently.
• Effective prioritization and efficiency in work.
• Ability to work autonomously and as part of a team.
• Highly organized and deadline-driven.
• Strong professional communication skills, both oral and written.

Ability to create PowerPoint presentations.

• Bachelor's Degree in a related field or equivalent experience.
• 7+ years of 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 similar database languages.
• Intermediate to expert in Power BI, Tableau, Qlik, or similar tools (preferred).

• Seniority level: Director
• Employment type: Full-time
• Job function: Research, Analyst, and IT
• Industry: Insurance

This job posting is active and available.