Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

Senior Data Analyst, Pharmacy

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Manager & Professional
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2108D Requisition #
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Work effectively with leaders of Pharmacy and other Departments to learn and understand stated goals, develop reports and provide analytics support to accomplish them. Interpret and utilize data and information to develop and provide recommendations for process improvements. Establish strong relationships within the company to leverage necessary subject matter expertise to reach solutions. Strive for innovative data analytics solutions; work with PBM to ensure accurate and effective reporting support.  

Responsibilities:

  • Generate complex data analytics projects using both Pharmacy and Medical data.  
    • Meet with internal and external business partners to determine the objectives and specifics of each project and create project plans
    • Create SAS code for each project to ensure efficient and repeatable reporting.  
    • Set milestones to ensure the projects are on track
    • Review each SAS log to ensure accuracy and document results, then obtain sign-off from immediate supervisor
    • Communicate clearly the details of the projects to the supervisor and the leadership
    • Maintain project dashboard and provide weekly updates to immediate supervisor 
  • Complete the data analytics projects efficiently. Determine if a request will be a one-time or a recurring project. If it is a recurring project, create a process to easily replicate.   
  • Pursue innovative data analytics solutionsusing advanced tools and predictive analytics.  
  • Follow the changes in the Health Care Industry closely and contribute to EmblemHealth turnaround 
  • Collaborate on complex special projects to support department with flexibility, for example Formulary Cost Analysis and Medical Utilization Management cost analysis. 
  • Utilization Management (UM) Reporting.
  • Maintain a process of daily, weekly, monthly and quarterly reporting
  • Interact with UM vendor for streamlined reporting solutions
  • Collaborate with CMS auditors on Program Audits, Timeliness Monitoring and various other types of audits
  • Create reports for NCQA accreditation project. Report the results to Pharmacy leadership to monitor timeliness of coverage determination reviews
  • Handle the Annual Health Plan Management System (HPMS) Data Submission. 
  • Develop quarterly review process
  • Establish strong QA process for accurate reporting
  • Assist management on special projects.  
  • Support New Plan Year implementation testing.  
  • Support CMS audits. 
  • Support financial statement audits. 
  • Provide support to cascaded projects and goals. 
  • Regulatory Reporting: 
  • Medicaid Managed Care Operating Report 
  • Special Investigation Unit reports 
  • Retiree Drug Subsidy Reports for USA, NYSHIP, MTA 
  • Other reports: 
  • OMT 
  • Upload and analyze cash receipt rebate files from ESI 
  • STARS and PPA reports 
  • ALPHA GH3, NonGH3, CCI Medicare, CCI HIX/Commercial table creation and maintenance 
  • Inpharmative data analysis and manipulation until vendor is sunset 
  • Various Ad Hoc Reports.
  • Other activities, including creating guides and training new team members. 

Qualifications:

  • Bachelor’s degree in Business, Finance, Health Administration, Math, Sciences, IT or related; Master’s preferred
  • Minimum of four (4) to six (6) years’ experience in data analytics required
  • Related experience in a PBM or Managed Healthcare setting preferred
  • Strong expertise with MS Office tools (including Access and Excel) required 
  • Programming experience or working knowledge of SAS or Oracle/SQL queries required
  • Effective communication (verbal, written, presentation) skills required
  • Experience working with Medicare Part D preferred
  • Reporting/Business Intelligence experience required
  • Understanding of financial concepts, claims processing concepts and knowledge of healthcare operating systems required

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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