Pharmacy Business Operations Analyst

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🔥 44 minutes ago

🏈 Ohio – Remote

🏈 Ohio – Remote

⏰ Full Time

🟢 Junior

🧐 Business Analyst

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University Hospitals

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

📚 Education

💰 $2M Grant on 2021-07

Healthcare • Medical Services • Education

University Hospitals is a leading healthcare provider that offers a wide range of medical services, including primary care, specialty care, and urgent care. With a focus on patient-centered care, UH also engages in medical education and research, ensuring high-quality treatment and innovative healthcare solutions. The institution is recognized nationally for its excellence in various medical specialties, providing accessible healthcare to the community and beyond.

📋 Description

• Monitor and manage operational workflows including claim queues, aging, and status tracking to ensure timely processing and resolution • Review and validate claim-level data for accuracy, completeness, and readiness for submission or follow-up • Track and investigate discrepancies between internal findings and external determinations (e.g., manufacturer or platform outcomes) • Partner cross-functionally with pharmacy operations, finance, 340B, revenue cycle, and analytics teams to resolve issues and improve workflows • Maintain issue logs for disputed claims, payment delays, data mismatches, and manufacturer-specific recurring issues • Perform financial reconciliation of expected versus actual payments, credits, and adjustments; escalate and resolve variances • Develop and maintain reporting on key metrics such as volume, aging, turnaround times, financial impact, and dollars at risk • Support development and maintenance of standard operating procedures, documentation, and control frameworks • Support annual readiness planning as additional negotiated drugs enter the MFP program • Analyze trends in claims, payments, and operational performance; provide actionable insights and recommendations • Contribute to ongoing process optimization and scalability initiatives across pharmacy business operations • Assist in readiness planning and implementation of new programs, policies, and regulatory requirements • Performs other duties as assigned. • Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients.

🎯 Requirements

• Bachelor's Degree healthcare administration, business, pharmacy, or related field (Required) or equivalent experience may be considered (Preferred) • 1+ years experience in pharmacy operations, reimbursement, 340B operations or payment reconciliation (Required) • Experience working with detailed data, including claim-level or transaction-level review (Required) • Strong analytical and problem-solving skills with attention to detail (Required) • Familiarity with 340B operations or manufacturer program processes (Preferred) • Experience with healthcare or pharmacy claims or payment workflows (Required) • Experience with business intelligence tools (e.g., Power BI, Tableau) (Preferred) • Exposure to SQL or other data querying tools (Preferred) • Experience with workflow or case management systems (e.g., Beacon or similar platforms) (Preferred) • Knowledge of pharmacy systems, reimbursement models, or regulatory programs (Preferred) • Ability to manage multiple priorities in a fast-paced, deadline-driven environment (Required proficiency) • Proficiency in Excel (e.g., large datasets, pivot tables, data analysis) (Required proficiency) • Demonstrated ownership mindset and ability to work independently (Required proficiency) • Strong written and verbal communication skills (Preferred proficiency) • Financial reconciliation and variance analysis (Preferred proficiency) • Strong documentation discipline and ability to manage high-volume operational work with short turnaround expectations (Preferred proficiency) • Operational analytics and process improvement (Preferred proficiency) • Data validation and reporting (Preferred proficiency) • Cross-functional collaboration and stakeholder management (Preferred proficiency) • Problem-solving and critical thinking (Preferred proficiency) • Process ownership and accountability (Preferred proficiency) • Adaptability in a dynamic regulatory and operational environment (Preferred proficiency)

🏖️ Benefits

• Complies with all policies and standards. • Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.