Senior Business Analyst – Pharmacy

🕒 August 24

🇺🇸 United States – Remote

💵 $64.9k - $92.7k / year

⏰ Full Time

🟠 Senior

🧐 Business Analyst

🦅 H1B Visa Sponsor

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👻 Ghost score 10%

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Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

📦 Logistics

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Consulting • Logistics • Healthcare Insurance

Gainwell Technologies is the nation’s leading provider of digital and cloud-enabled solutions across the human services and public health ecosystem. With a mission-driven approach, Gainwell serves clients in all 50 U. S. states, focusing on improving health outcomes and delivering intuitive, human-centered experiences. Their comprehensive suite of solutions includes Medicaid Enterprise modernization, data analytics, provider services, and pharmacy solutions, all designed to advance the future of healthcare and enhance community well-being.

📋 Description

• Ensure Gainwell meets clients’ objectives in pharmacy benefit management (PBM) services • Support PBM or drug rebate implementations and configurations • Support PBM operations and maintenance on established accounts • Configure pharmacy systems with pharmacy clinicians and subject matter experts to deliver services to state clients • Assist in implementing a pharmacy payer system • Perform pharmacy updates, including benefit plan design, edit/audit setup, utilization controls, PDL, configuration updates, and auto prior authorization parameters • Define, document, and share pharmacy business requirements and expected impact with operations staff, clients, project managers, and technical staff • Work with clients to develop business rules and configuration requirements • Analyze, plan, design, document, or recommend business process improvements supporting client technology goals • Verify requirements by approving and validating test results • Test point-of-sale (POS) pharmacy claims as required • Use Excel or SQL to quantify anticipated work impact

🎯 Requirements

• Six (6) or more years of experience in a relevant pharmacy business analyst or pharmacy technician position • 3 or more years of Medicaid and Medicare experience preferred • Knowledge of computer programming concepts such as configuration, development, data conversion analysis, and batch processing • Advanced knowledge of Microsoft Excel or SQL and requirement-mapping tools such as Application Lifecycle Management (ALM) tools • Strong communication skills, including translating client needs into actionable objectives and presenting to business, technical, and executive audiences • Strong analytical abilities with experience in business process re-engineering and problem solving • Highly organized with the ability to prioritize tasks, manage workload effectively, and operate independently • Pharmacy experience as a Pharmacy Technician or working for a PBM • Knowledge of drugs and drug file structures through FDB, Medispan, or Micromedex • Knowledge of the pharmacy payer process/claims processing • Experience working with drug file data or NCPDP guidelines • Knowledge of prior authorization processes and criteria preferred

🏖️ Benefits

• Work flexibility • Learning and career development • Generous, flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies • Up to 10% travel for client meetings, requirement review, or implementations