PBM Regulatory Reporting Analyst

📋 Description

• • Assist with compiling quarterly Pharmastar compliance reports to ensure adherence to internal and regulatory procedures.
• • Prepare and analyze PDE, PDE Rejections, FIR reports, and plan rebate reports for accuracy and completeness.
• • Support PACE Bid preparation by collaborating with external auditors and ensuring regulatory alignment.
• • Manage weekly financial billing activities, including plan admin fees and pharmacy network payment review reporting.
• • Handle Action Required reporting, member authorizations, and related compliance activities.
• • Prepare, test, and submit NDPDP Pharmacy Encounter data files, including error review and resolution.
• • Conduct quality assurance on existing reports and adjudication results to identify discrepancies and recommend improvements.
• • Review report outputs for errors and proactively suggest process changes to enhance accuracy and efficiency.
• • Respond to internal ticketing system requests and inquiries in a timely and accurate manner.
• • Generate customized reports to meet client and internal support needs, updating formats and content as required.
• • Ensure all client communications strictly comply with HIPAA guidelines and confidentiality standards.
• • Stay current on Medicare Part D guidelines, plan and benefit structures, and pharmacological updates to maintain regulatory compliance.
• • Attend department and company meetings, training sessions, and educational programs as requested.
• • Assist in preparing and disseminating Pharmastar claim audit results to clients in summary format.
• • Participate in deployment activities related to separation of duties and internal control enhancements.
• • Operate computer systems and office machinery including calculators, printers, and fax machines to perform daily tasks.
• • Maintain high standards of accuracy, attention to detail, and confidentiality in all reporting and client interactions.
• • Work independently and collaboratively across teams to support client satisfaction and operational efficiency.
• • Adapt to ad-hoc scheduling needs outside standard business hours to meet client expectations.
• • Perform duties requiring prolonged sitting, visual acuity for data analysis, and occasional light lifting (up to 20 pounds).
• • Communicate professionally via phone and computer with providers, participants, customers, and vendors.
• • Utilize Microsoft Excel extensively for data analysis, reporting, and documentation.
• • Apply knowledge of government healthcare programs, pharmacology, and PBM operations to support regulatory reporting.
• • Demonstrate strong analytical, research, and problem-solving skills to resolve reporting and compliance issues.
• • Prioritize multiple projects and manage time effectively in a fast-paced, deadline-driven environment.
• • Maintain a customer-focused approach while handling sensitive health data and client inquiries with tact and professionalism.