AnewHealth is one of the nation's leading pharmacy care management companies that specializes in caring for people with the most complex, chronic needs-wherever they call home. We enable better outcomes for patients and the healthcare organizations who support them. Established in 2023 through the combination of ExactCare and Tabula Rasa HealthCare, we provide a suite of solutions that includes comprehensive pharmacy services; full-service pharmacy benefit management; and specialized support services for Program of All-Inclusive Care for the Elderly. With over 1,400 team members, we care for more than 100,000 people across all 50 states.

Job Details

The Pharmacy Benefits Regulatory Operations Analyst is responsible for ensuring Pharmastar's adherence to both internal and regulatory procedures. This position assists with various internal tasks that ensure a high level of compliance for the PBM and its clients. On the job training will be provided.

Essential Functions:

• Participates in regulatory audit proceedings.
• Coordinates PBM Licensing - primary point of contact for our licensing partner, maintains spreadsheet of states serviced and licensing status, responds to requests from state regulatory agencies, works with internal teams to provide required information for licensing.
• Conducts targeted pharmacy audits and distributes plan specific audit result letters.
• Handles pharmacy audits associated with CMS 1/3 Financial Audits
• Researches and reports relevant documentation for clients' CMS financial audits
• Develops Corrective Action Plans (CAPs) in response to audit findings.
• Monitors Medicare Part D regulation and guidance for applicability to Pharmastar. Assists with facilitating client awareness of regulatory changes.
• Monitors OIG alerts and requests database queries as needed.
• Manages CMS memo requirements - (high risk prescribers/pharmacies/prescriber outliers/risk assessments/etc) request reporting, distribute email to Client Relations with summary of required client communication.
• Creates Pharmastar Bulletin summarizing CMS memos for client consumption.
• Responsible for maintaining P&P platform for Pharmastar includes drafting and editing as well as delegating staff for yearly reviews.
• Processes P2P payments.
• Ensures that HIPAA guidelines are followed in every communication with clients.
• Stay current on plan and benefit structures, pharmacological updates, and Medicare Part D guidelines.
• Attend department and company meetings and educational programs upon request.
• Other related duties as assigned.

The listing of essential functions is not to be considered an exhaustive list of all duties that may be performed.

Qualifications:

• Associate's degree preferred. High School Diploma or equivalent required.
• 2 years of audit and industry experience.
• 2 years of Healthcare industry experience, required. (Health plan or insurance experience, a plus. PBM experience preferred.)
• CPhT (Certified Pharmacy Technician) certification, a plus.
• Experience reviewing and interpreting regulatory business requirements.
• Current on plan and benefit structures and Medicare guidelines.

Knowledge, Skills, Abilities:

• Knowledge of government health care program.
• Knowledge of pharmacology and pharmacological terms.
• Excellent verbal and written communication skills and professionalism when working with clients.
• Ability to provide tactful responses under stressful situations and conditions.
• Detail oriented with strong analytical and research skills.
• Ability to multi-task and prioritize projects.
• Able to maintain the highest standard of confidentiality.
• Ability to work well with many different personality types.
• Strong customer focus.
• Strong computer skills including using word processors, spreadsheets, and database software.

AnewHealth offers a comprehensive benefit package for full-time employees that includes medical/dental/vision, flexible spending, company-paid life insurance and short-term disability as well as voluntary benefits, 401(k), Paid Time Off and paid holidays. Medical, dental and vision coverage are effective 1st of the month following date of hire.

AnewHealth provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment. Applicants are encouraged to confidentially self-identify when applying. Local applicants are encouraged to apply. We maintain a drug-free work environment. Applicants must be eligible to work in this country.