SCAN · 1 hour ago
Pharmacy Analyst I
United States
Full-time
Remote
New Grad, Entry Level
$25.38/hr - $36.76/hr
0+ years expSCAN is a nonprofit health organization dedicated to improving care for older adults. The Pharmacy Analyst I supports daily operations and compliance with Part D activities, managing data and collaborating with various teams to ensure adherence to Medicare requirements.
Elder CareHealth CareHome Health CareMedical
Responsibilities
Serve as a subject matter expert for Part D Reporting requirements, Pharmacy Access Requirements, Prescription Drug Event data, Financial Information Reporting and Drug Plan Finder files by keeping up to date with Medicare requirements
Ensure eligibility and coordination of benefit files are sent to the PBM for processing and assess if file enhancements are needed. Ensure the PBM is processing Prescription Drug Events, Automated Claims Reprocessing and Financial Information Data according to CMS regulatory standards by conducting daily oversight. Ensure PBM oversight of claims adjudication and retrolics and ensure 1/1 Readiness related to eligibility
Analyze and monitor large data sets that are exchanged from SCAN to the PBM using a variety of reporting tools
Ensure audit documentation is prepared according to audit instructions and provided within the specified audit time frame. Prepare written responses or documentation for pharmacy audits
Perform routine monitoring to ensure Part D compliance and detect performance issues or operational gaps
Assist in the implementation, testing, and validation of pharmacy benefits to ensure accurate benefit configuration and claims adjudication
Collaborate with cross-functional teams, including Compliance, Product, and IT, to address issues and support PDE and other pharmacy initiatives
Identify and escalate issues related to pharmacy benefits, claims processing, and PDE submissions, working with the PBM and internal teams to resolve discrepancies
Maintain professional and technical knowledge by attending educational workshops; reviewing professional publications & CMS regulatory requirements; establishing personal networks; participating in professional societies
Contribute to the development, maintenance, and documentation of standard operating procedures (SOPs) and desktop procedures to support compliance and operational efficiency
We seek Rebels who are curious about AI and its power to transform how we operate and serve our members
Actively support the achievement of SCAN’s Vision and Goals
Other duties as assigned
Qualification
Required
0-3 years of related experience
High School Diploma or equivalent experience required
Expert knowledge of CMS Part D regulations e.g., CMS Call Letters, MA-PD application, PDE, LICS, Claims Processing, Part D Reports, FIR
Knowledge of PDE calculations that pertain to Enhance Alternative Plans, Coverage Gap, etc
Ability to prioritize workload to meet deadlines
Ability to multi-task in a fast pace environment
Ability to interact effectively and professionally with all levels of staff
Excellent grammar and writing skills
Excellent verbal skill sets to be able to communicate in conference calls and in large meetings
Team player with a strong work ethic
Self-starter that can take the lead on a project and manage its progress for completion
Detail oriented and is able to work with large data sets
Advanced skills with Microsoft Office (e.g., Word, Excel, Access, Outlook, and PowerPoint) and SQL
Preferred
Bachelor's Degree or equivalent experience preferred
Familiarity with Tableau and Visio
Benefits
An annual employee bonus program
Robust Wellness Program
Generous paid-time-off (PTO)
11 paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday
Excellent 401(k) Retirement Saving Plan with employer match and contribution
Robust employee recognition program
Tuition reimbursement
Company
SCAN
About SCAN Keeping Seniors Healthy and Independent–that’s been our mission for more than 40 years.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Lyn Amor Macaraeg
CVP Chief of Staff & Strategic Advisor to the CEO
Sachin H. Jain, MD, MBA
President and CEO, Board Director
Recent News
2025-12-26
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