Pharmacy Business Intelligence Engineer

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MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Bachelor’s Degree in Business Administration, Mathematics, Computer Science, Statistics, Information Systems, or a related field

EXPERIENCE:

1. Five (5) years' experience in quantitative analytics and conducting advanced analytic modeling for large pharmacy and clinical datasets.

2. Three (3) years of experience working with claims data to evaluate reimbursement changes, payment discrepancies, medical expense opportunities, quality outcomes and risk

PREFERRED QUALIFICATIONS:

EXPERIENCE:

1. Master’s Degree in Business Administration, Computer Science, Statistics, Information Systems, or a related field

2. Three (3) years of experience working with Medicare and/or Medicaid Data

3. Understanding of Medicare and/or Medicaid Regulatory Reporting, e.g., WV Department of Insurance, Department of Medicaid/Health Services and CMS

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1. Knowledgeable in building complex queries using SAS Enterprise Guide and then translating data into actionable visual dashboards using SAS Visual Analytics

2. Work cross-functionally with the Pharmacy team to develop and deliver actionable reports and dashboards, providing actionable insights and recommendations to the Pharmacy team.

3. Communicate complex data analysis results effectively via reports and dashboards to stakeholders and provide actionable recommendations for drug utilization.

4. Responsible for, but not limited to, the analytical functions for creating and refining standard pharmacy services data processes that allow for scalability of PBM services and strategies.

5. Utilize extensive knowledge of PBM industry practices, regulations, and market trends.

6. Use advanced statistical analysis techniques to evaluate the effectiveness of our PBM programs and devise measures for assessing efficacy on a recurring basis.

7. Upholds the health plan mission of making health care more accessible, understandable, and collaborative while interacting with colleagues.

8. Assist with the development, improvement, and maintenance of data models and reporting systems to support key business decisions

9. Leverages complex analytical tools to provide business and technical expertise to create data driven solutions

10. Partner with product, operations, medical management, and provider contracting teams to understand & anticipate reporting requirements, priorities, and key performance indicators

11. Provide thought leadership to key business stakeholders, translating data into actionable insights using appropriate analytical solutions

12. Participate in a variety of assigned operations initiatives to ensure success in meeting business goals and objectives

13. Provide mentoring and guidance to Business Analysts on processes and practices related to repeatable and ad-hoc reports, defining business cases, and supporting key business stakeholders

14. Conducts training sessions for colleagues on the Operational Analytics team

15. Collect report requirements – interview and research business stakeholder needs; draft, edit and validate requirement documentation

16. Ongoing assessment of operational report efficiencies within the health plan and making recommendations to correct inefficiencies

17. Collaborate effectively with customers in all phases of Business Intelligence development, potentially including requirements gathering, design, testing and change management

18. Provide input to business cases, contracts, project plans, scope of work, status and project summary reports

19. Provide input on strategies and tactics regarding platforms, tools, and technical staffing to meet customer needs

20. Initiates and maintains effective channels of communication with matrix partners including but not limited to Claims Operations, Medical Management, Provider Contracting, and Member and Provider Services. This position will be responsible for resolving issues through their ability to produce meaningful and impactful analytics reports.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Must be able to sit for long periods of time.

2. Must have manual dexterity needed to operate computer and office equipment.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Standard office/home working environment

SKILLS AND ABILITIES:

1. Strong programming skills with query languages such as SQL and the ability to perform effective querying from multiple tables and databases.

2. Experience with querying tools such as SAS Enterprise Guide, Microsoft SQL Server Management Studio, and Power BI

3. Experience with data visualization tools such as SAS Visual Analytics and Tableau

4. Experience working with Oracle, Teradata, Hadoop, etc.

5. Strong problem solving and quantitative abilities

6. Excellent communication and collaboration skills

7. Attention to detail

8. Experience with Commercial (self-funded and fully funded), Medicare, and Medicaid products

9. Working knowledge of claims, utilization management, member, and/or provider data

10. Strategic thinking

11. Effective time management and organizational skills

12. Work independently as well as in a team environment

13. Proficient computer skills, including experience with Microsoft Office Suite such as Excel functionality (pivot tables, vlookups, macros, etc.)

Additional Job Description:

Scheduled Weekly Hours:

Shift:

Exempt/Non-Exempt:

Company:

Cost Center: