Senior Data Analyst, Quality Review - Medicare Pharmacy Claims Part D & Part B)

**Job Description**

We're hiring a Senior Data Analyst to join the Government Pharmacy Programs Department! The Senior Data Analyst, Quality Review – Medicare Pharmacy Claims is responsible for ensuring accurate, compliant adjudication of Medicare Part D and Medicare Part B pharmacy claims. This role performs detailed quality oversight, validates benefit and pricing logic, ensures adherence to CMS regulations, and identifies systemic issues that impact claims accuracy, financial performance, and member outcomes.

**What You'll Do**

+ Perform comprehensive quality reviews of **Medicare Part D and Part B pharmacy claims** , including retail, mail order, LTC, specialty, and medical‑benefit drug claims
+ Validate accurate application of:
+ Medicare Part D phases (Deductible, Initial Coverage, Catastrophic)
+ Low‑Income Subsidy (LIS) cost‑sharing
+ MOOP accumulations
+ PDE data elements and claim submission logic
+ MAC list pricing
+ Pharmacy...