What are the responsibilities and job description for the Data Analyst / Scientist - SQL, Python, R - Pharmacy Benefit Mgmt experience - 100% Remote position at Conexess Group, LLC?
Data Analyst / Scientist - SQL, Python, R - Pharmacy Benefit Mgmt experience - % Remote
United States - Preferably ET / CT - % Remote
Mid - Sr. Level - Must have PBM experience
The PBM Data Analyst / Scientist is responsible for summarizing, analyzing, and interpreting pharmaceutical data to support strategic decision-making processes. The primary objective is to enhance the efficiency and effectiveness of pharmacy benefit programs while ensuring cost containment and delivering high-quality patient care. This role demands a keen eye for detail, strong analytical skills, and a collaborative approach to problem-solving.
The client is transitioning their adjudication platform from an external vendor to an internally developed system. To support this migration, they have allocated a significant number of internal resources to the project. However, they require additional personnel to assist with the workload and to take on tasks that their internal teams are unable to complete.
Job Responsibilities :
- Gather and compile pharmacy and healthcare-related data from various sources, including claims, prescriptions, and pharmacy networks, ensuring comprehensive data capture.
- Ensure data accuracy, completeness, and consistency through rigorous validation and cleaning processes to maintain high data quality standards.
- Apply statistical and analytical techniques to identify trends, patterns, and anomalies in pharmaceutical claim data, providing actionable insights to support decision-making.
- Perform cost-benefit analysis and cost-effectiveness studies for different medication and treatment options, helping to optimize financial and clinical outcomes.
- Create reports, dashboards, and visualizations using tools like Domo, Tableau, or Power BI, effectively conveying insights and findings to various stakeholders, including senior leadership and cross-functional teams.
- Compare data from different time periods and between different types of customers to better assess which plan actions are working and to what degree.
- Utilize predictive modeling and forecasting techniques to project future pharmacy benefit program costs and utilization patterns, aiding in strategic planning and budgeting.
- Assess the impact of different benefit design changes on costs and patient outcomes, providing data-driven recommendations for program adjustments.
- Stay updated with healthcare regulations and ensure that pharmacy benefit programs comply with relevant laws and regulations, including those related to data privacy and security.
- Assist in audits and compliance reporting as necessary, ensuring transparency and adherence to regulatory requirements.
- Provide data-driven recommendations for optimizing pharmacy benefit programs, including formulary management, prior authorization criteria, and cost-saving strategies.
- Collaborate with cross-functional teams including Pharmacists, Account Managers, and IT professionals to implement recommended changes and enhance program performance.
- Implement data validation processes to ensure data integrity and accuracy, troubleshooting data-related issues and discrepancies promptly.
- Communicate complex data analyses clearly and understandably, tailoring messages to diverse audiences, including technical and non-technical stakeholders.
- Develop and disseminate best practices for researching and answering our clients' questions about their benefit experiences and efficacies.
- Proficiency in data analysis tools such as SQL, Python, or R, and familiarity with data visualization tools like Domo or Power BI, enabling robust and efficient data handling.
- Familiarity with PBM software and pharmacy claims processing systems, ensuring seamless integration and analysis of diverse data sources.
- Ability to maintain the confidentiality of sensitive medical information and knowledge of HIPAA Privacy and Security Rules
- Abide by all obligations under HIPAA related to Protected Health Information (PHI).
- If a HIPAA violation is discovered, whether individually or by another, you must report the violation to the Compliance Officer and / or Human Resources.
- Attend, complete, and demonstrate competency in all required HIPAA Training offered by the company.
- Flexibility to understand, appreciate, and embrace that this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee. Duties, responsibilities, and activities may change, or new ones may be assigned at any time with or without notice.
Skills and Experience Required :
Required
Desired
Education
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