Pharmacy Data Analyst position with Tufts Health Plan

in Jobs
April 3rd, 2014


1.       Please send resume only to Tufts Health Plan website (Req. #14-4571). Please note that the website job posting asks for 5 years of experience.  This has been changed to 1-2 of experience as noted below.

2.       Additionally, email resume to Ms. Jean Preston, Director, Clinical & Specialty Pharmacy at


Under the direction of the Director, Clinical & Specialty Pharmacy, the Pharmacy Data Analyst is responsible for managing data and workflows associated with formulary and pharmacy program decision-making and implementation.  Designs and maintains databases of formularies and pharmacy programs, and analyzes large data files for the Pharmacy Services department.  Records, maintains, and publishes documentation as required by regulatory and accreditation organizations.  Manages communications with partner departments.



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Database Management

Designs and maintains databases of formularies and pharmacy programs for program evaluations, competitor comparisons, and responses to request for proposals.  Summarizes data and prepares reports of drug coverage by drug category and pharmacy program.  Designs and maintains databases of pharmacist consultations, and prepares quarterly summary reports.  Supports Clinical Pharmacy and Analysis & Reporting Teams in analysis of large data files.


Formulary Maintenance

Works with designated Clinical Pharmacists to prepares and submit coding requests for maintenance of multiple formularies to Pharmacy Operations team for coding in the Pharmacy Benefit Management (PBM) adjudication system.  Updates web postings of pharmacy Medical Necessity Guidelines (MNGs), and prepares summary grid of changes by month.


Pharmacy Fee Appeals

Works with Claims Departments to process pharmacy fee appeals for claims that have been billed in excess of standard claims edits and unit maximums.  Prices drugs billed with miscellaneous codes, confirms that units billed are appropriate, calculates drug dose and units for weight-based drugs, and forwards appeals based on clinical justifications to Clinical Pharmacist and/or Medical Director.


Web Publishing

Maintains Pharmacy Services ALUI community to provide content, resources and references to facilitate pharmacy benefit coverage determinations and processing by our partner departments, including Precertification, Medical Affairs, and Appeals & Grievances.  Works with partner departments to identify additional content for development, and facilitates periodic updates to the content. 


Contracted Provider Set-up/Maintenance

Works with Senior Contract Administrator to set-up contracted Home Infusion and Specialty Pharmacy providers in the Commercial TAHP and Medicare Advantage Diamond claims systems.  Maintains fee schedules with Commercial and Medicare Advantage Provider Reimbursement and conducts audits for accuracy.


Medication Therapy Management Program Workflows/Reports

Works with Senior Contract Administrator responsible for contract for Medication Therapy Management (MTM) program to conduct vendor monitoring, data validation, and reporting.


Records Retention

Records and maintains documentation as required by regulatory and accreditation organizations for Pharmacy & Therapeutics (P&T) and Drug Coverage Committee (DCC), and pharmacy MNGs.  Ensures that Clinical Pharmacy records are maintained consistent with the Records Retention Policy.  Maintains security and confidentiality of data and documents, as required.  


Team Contact/Liaison

Acts as an internal and external contact for Clinical Pharmacy team.






EDUCATION: (Minimum education & certifications required)

Bachelor’s degree in business or related field required.  Master’s degree in business administration or public health preferred. 

Coursework in project management and/or industrial engineering preferred.


EXPERIENCE:  (Years of experience)

1-2 years of experience in health care or health insurance industry preferred (this may include internships).  Ability to develop and maintain databases required.  Must be proficient in MS Office applications, including MS Access and MS Excel, and able to learn/utilize company-specific claim systems, databases, and document management systems. 


SKILL REQUIREMENTS: (Include interpersonal skills)

Excellent analytical skills necessary to interpret pharmacy data and reports and to prepare summary documents.  Requires a high degree of initiative to anticipate the data needs of the department and to research available data sources.  Must have excellent oral and written communication skills, including preparation of presentation-ready materials. 


Must be able to work both independently and cooperatively as a team member.  Excellent interpersonal skills required with a high level of diplomacy to recognize and respond to politically sensitive issues.  


WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS: (include special requirements, e.g., lifting, travel, overtime)

Fast paced office environment handling multiple demands.  Must be able to exercise appropriate judgment as necessary. Open cubicle work setting with a personal computer.


CONFIDENTIAL DATA:  All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential.  Exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations at all times.


Requires high degree of confidentiality with regard to financial and political issues associated with contractual agreements.