PBM Regulatory Reporting Analyst

ExactCare

Regulatory Reporting Analyst assisting with compliance for pharmacy benefits management at AnewHealth. Focused on reporting, documentation, and client satisfaction while supporting healthcare organizations.

Posted 6/25/2026full-timeRemote • 🇺🇸 United StatesJuniorWebsite

Tech Stack

Tools & technologies

SQL

About the role

Key responsibilities & impact

Assist with compiling Quarterly Pharmastar Compliance reports
Assist with preparation and analysis of PDE, PDE Rejections, FIR reports, and plan rebate reports
Assist with PACE Bid preparation, including working with external auditors
Assist with weekly Financial Billing, plan admin fees, pharmacy network payment review reporting and activities
Handle Action Required reporting, associated member authorizations and related activity
Create NDPDP Pharmacy Encounter data file preparation, testing and submission, and error review
Assist with QA of existing reports and adjudication results
Review report output for issues for proactive recommendations for change
Respond to internal ticketing system requests and inquiries
Generate reports to meet clients’ needs and internal support needs and make updates where appropriate
Ensure 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.

Requirements

What you’ll need

Associate’s degree preferred
High School Diploma or equivalent required
1+ years of audit/quality and PACE 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 in a pharmacy support role, a plus
Proficiency in Microsoft Excel required
A strong understanding of TOAD, SSRS, or T-SQL, a plus

Benefits

Comp & perks

Medical, dental and vision coverage are effective 1st of the month following date of hire
Flexible spending
Company-paid life insurance and short-term disability
401(k)
Paid Time Off
Paid holidays

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

data analysisreport generationquality assuranceerror reviewfinancial billingpharmacy encounter data preparationauditPDE analysisT-SQLSSRS

Soft Skills

communicationorganizationalproblem-solvingattention to detailproactive recommendations

Certifications

CPhT (Certified Pharmacy Technician)