PBM Compliance & Reporting Consultant

In this multi-disciplinary, cross functional role, the Consultant, PBM Compliance and Reporting will report to the Director, Pharmacy Pricing & Analytics. The Consultant, PBM Compliance and Reporting is a key contributor to the CMS and regulatory reporting for the Commercial Pharmacy line of business. This role is responsible for updating, executing, and providing strategic direction for compliant reporting. Additionally, this role’s functions include participation in any testing and audit functions, as required by regulatory bodies. The Consultant assists with resolving data issues involving performance discrepancies, claims, and information technology. This role will continue to develop and support the process of evolving Pricing and Analytics functions for existing and new PBM partnerships. The successful Consultant, PBM Compliance and Reporting will be able to manage multiple projects at once, stay abreast of a dynamic regulatory environment, and champion our mission and culture.

Essential Job Responsibilities Include:

• Ensure compliance with all government policies and requirements, monitoring and completing regulatory reporting requirements and other deliverables
• Understand and articulate Commercial pharmacy program guidelines and regulations for state and government agencies
• Assist with completing government reporting requirements and deliverables with extreme accuracy and timeliness
• Stay abreast of regulatory changes, including the ability to read and understand regulatory documentation / guidance at a state and federal level. Must be able to translate that information into accurate, compliant reporting.
• Update and maintain client and vendor contracts/agreements
• Support claims audits other inquiries
• Work cross functionally with clients as needed to gather information and complete deliverables.
• Act as a cross-functional representative throughout the organization to provide strategic insight and support organization goals and initiatives
• Lead the development and application of advanced analytics techniques driving operational efficiencies, providing consultative support, enabling informed decision making, and producing KPIs for senior leadership
• Analyze data to uncover potential issues / provide financial impacts
• Provide custom analytics/modeling for ad-hoc projects

Required Skills / Experience:

• 3 – 5 years of experience in CMS reporting
• Knowledge of state and government (CMS) requirements for Commercial pharmacy benefit managers
• Four-year college degree from an accredited institution.
• Advanced MS Excel user (vlookups, pivot tables, file merging, etc.)
• Ability to utilize data softerware (SAS, SQL, PYTHON, SNOWFLAKE)
• Proven communication and relationship building skills required.
• Strong analytical and organizational skills required.
• Significant attention to detail and high-level time management skills required.

Based on relevant market data and other factors, the anticipated hiring range for this role is $88,000 - $110,000 annually. Final compensation rates will be determined based on various factors, including but not limited to experience, skills, knowledge, and internal equity considerations. This role is also short-term incentive eligible. Incentive amounts will vary by individual and business goals. 

We are committed to fair and equitable compensation practices. The final salary offered to the selected candidate may vary from the posted range due to individual qualifications. Our goal is to ensure that all teammates are compensated fairly and competitively based on their contributions to our organization.

RxBenefits is also committed to providing best in class benefits to our teammates.  We offer a robust total rewards package that includes:

• Remote first work environment
• Choice of a HDHP or PPO Medical plan, we pay 100% of the premium for the HDHP for you and your eligible family members
• Dental, Vision, Short- and Long-Term Disability, and Group Life Insurance that we also pay 100% of premiums (for your family too on Dental and Vision)
• Additional buy-up options for Short- and Long-Term Disability and Life Insurance
• 401(k) with an employer match up to 3.5% available after 60 days
• Community Service Day to give back and support what you love in your community
• 10 company holidays including MLK Day, Juneteenth, and the day after Thanksgiving plus a floating holiday to use as you like
• Reimbursements for high-speed internet, we’ll send you a computer and monitors to help you do your best work
• Tuition Reimbursement for accredited degree programs
• Paid New Parent Leave that can be used for adoption or birth
• Pet insurance to protect your furbabies
• A robust mental health benefit and EAP service through Spring Health to support you when you need it most