Healthcare Data Systems SME I

Data Systems SME 1

Overview

J29, Inc. (J29) has been supporting commercial, State, and Federal health and human service programs since company inception in 2017 as a healthcare management consulting company. Our team of 260 employees focuses on providing processing, review, and analysis of medical claims, records, data, and audits between areas of compliance, policy, and clinical expertise. Our team is experienced in program, payment, provider, and patient integrity as we continue to support advanced programs of policy, clinical requirements, and compliance measures at the commercial, State, and Federal levels. J29 was founded to be an employee-centric company that prioritizes the well-being and value of its employees. Our mission is to empower our employees to do great things for the benefit of those that need it most. The J29 mission supports not only our health and human service programs, but also the philanthropy efforts of our team. We are proud to continue our support to non-profit groups with critical missions as J29 continues to grow. Job Summary Data Systems SME 1 performs data analysis, technical support, and report preparation. Studies originate from raw and/or preliminary data analysis (trends), literature review, experience and expertise of the team, and mandated projects. Reports are drafted by teams with leadership of Program Manager and Pharmacy SMEs. Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Analyze raw and/or preliminary trend data to identify potential opportunities (e.g., variances, significant outliers, percentile ranked groups) for quality improvement or focused investigations.
• Provide expert analytical and technical support across key pharmacy/healthcare related tasks, including data interpretation, cost trend analysis, and development of methodologies aligned to program goals.
• Aid in design data analysis strategies to identify potential areas for quality improvement or focused investigation.
• Develop and maintain high‑quality, repeatable analytical processes and system workflows that ensure data accuracy, timeliness, responsiveness, and compliance with applicable quality standards.
• Analyze data, draw conclusions, and summarize into reports.
• Develop and/or populate tabular and graphical presentations of data.
• Support program by evaluating, modernizing, and operationalizing pharmacy‑related data systems by applying expert‑level understanding of pharmacy benefit structures, pricing models, and clinical or operational data flows.
• Produce actionable insights, reports, and recommendations that translate complex data trends into clear guidance for leadership and stakeholders in support of program oversight and continuous improvement.
• Collaborate with cross‑functional SMEs and government teams to ensure alignment with program goals, support staffing and transition planning, and maintain compliance with client Business Associate Agreement (BAA) requirements.
• Familiar with commonly used concepts, practices and procedures, relying on instructions and pre-established guidelines to perform the functions of the job.
• Support development of reports concerning all of the above.

Competencies

To perform the job successfully, an individual should demonstrate the following competencies:

Analytical - Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data. Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions. Judgment - Exhibits sound and accurate judgment; Supports and explains reasoning for decisions.

Qualifications

• Bachelor’s degree in data science, public health, pharmacy, health informatics, statistics, computer science, or a related field.
• Advanced degrees preferred (MS, MPH, PharmD, MBA with analytics emphasis).
• Minimum of five (5) years working with pharmacy, healthcare, or claims data systems - including analytics, data engineering, data quality management, or related functions.
• Deep understanding of pharmacy claims data (e.g., NCPDP, NDC, formulary attributes, network data).
• Experience with federal data environments, large‑scale datasets, and enterprise data warehouses.
• Proficiency in statistical analysis, modeling, or analytic tools (e.g., SQL, SAS, R, Python, Power BI).
• Experience in at least four key areas, such as:
• Pharmacy benefit management (PBM) data operations
• Pricing or financial modeling
• Clinical or formulary analytics
• Benefit design modeling
• Data system architecture or data governance
• Minimum of five (5) years of experience supporting government pharmacy or healthcare benefit administration, such as DoD (preferred), VA, CMS, or similar.

Language Skills

• Ability to read, analyze, and interpret common scientific and technical and professional journals, technical procedures, or governmental regulations.
• Ability to write reports, business correspondence, and procedure manuals.
• Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.

Mathematical Skills

• Ability to apply advanced mathematical concepts such as probability and statistical inference.
• Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
• Ability to apply mathematical operations to such tasks as frequency distribution, determination of test reliability and validity, analysis of variance, correlation techniques, sampling theory, and factor analysis.

Reasoning Ability

• Ability to define problems, collect data, establish facts, and draw valid conclusions.
• Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.

Other Skills and Abilities

• To perform this job successfully, an individual should have fluency in SAS or other statistical programming software and MS Office.
• Ability to work independently and in teams.
• Must possess familiarity with statistical and epidemiological methodologies, and automation techniques for analytic tasks.
• Ability to work with highly sensitive information while preserving the confidentiality of the information.
• Working knowledge of healthcare systems, Medicare/Medicaid preferred, healthcare databases and coding systems.

J29, Inc. is committed to hiring and retaining a diverse workforce. We are proud to be an Equal Opportunity/Affirmative Action Employer, making decisions without regard to race, color, religion, creed, sex, sexual orientation, gender identity, marital status, national origin, age, veteran status, disability, or any other protected class. J29, Inc. is a proud Veteran friendly employer.