The Director 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 our compliance reporting efforts and partner with key business stakeholders.
Key Responsibilities
- 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 to support organization compliance requirements
- Maintain and manage large datasets related to Medicare Part D and other relevant programs
- Monitor performance through tracking trends and identifying discrepancies in subsidy allocations and prescription drug events
- Work with cross-functional teams, including finance, IT, Account Management, and Compliance to optimize Medicare data usage
- Lead process improvement through developing strategies to enhance data collection, reporting, and analysis efficiency
- Design, build, and maintain business intelligence reporting in collaboration with team leadership
- Continually focus on growing technical skills related to reporting tools and coding languages
- Partner with leadership and other key business contacts to ensure Medicare data and reporting knowledge is developed and maintained
- Support ad-hoc and reoccurring work as needed
Qualifications
- Highly creative and possess the ability to manage several projects concurrently
- Ability to prioritize effectively and to work efficiently
- Ability to work both autonomously and together as a team
- Highly organized and deadline driven
- Professional communication skills, both oral and written to all levels of an organization
Ability to create PowerPoint
Knowledge, Experience, And Education
- Bachelor’s Degree in related field, or equivalent experience
- 7+ years’ 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 other database languages
- Intermediate to expert in Power BI, Tableau, Qlik, or similar tool, preferred
