Business Analyst – Pharmacy IT

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $51.9k - $74.2k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🧐 Business Analyst

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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

• Gather, document, and validate business, functional, and technical requirements for pharmacy IT systems, including POS, DUR, claims processing, RTBT, and Preferred Drug Lists • Translate CMS, Medicaid, and rebate program updates into business and system requirements • Collaborate with stakeholders, pharmacists, SMEs, and IT teams to define scope, requirements, and acceptance criteria • Analyze pharmacy claims processing, NCPDP standards, pricing and reimbursement methodologies, and drug file updates • Support system design for DUR, prior authorization workflows, clinical edits, drug coverage, formulary management, and rebate processing • Develop and maintain use cases, workflows, data mappings, and configuration documentation • Create test plans, scenarios, and scripts for pharmacy system enhancements • Conduct UAT, regression testing, and validation activities • Document defects, coordinate resolution efforts, and verify outcomes meet requirements • Support project planning, sprint activities, release cycles, and cross-functional coordination • Prepare status reports, business documentation, and stakeholder communications • Facilitate requirements workshops, meetings, and stakeholder review sessions • Monitor pharmacy program policies, CMS guidance, and regulatory changes to assess system impacts • Assist operational teams with claims issues, reimbursement discrepancies, and provider concerns • Support audits, compliance initiatives, and required documentation deliverables

🎯 Requirements

• Bachelor’s degree in Business, Healthcare, Information Systems, Pharmacy, or related field • 2+ years of experience in business analysis • Strong understanding of pharmacy benefit management operations and terminology • Familiarity with NCPDP standards, pharmacy claims processing, drug file management (Medi-Span/First Databank), and pricing methodologies • Experience writing business requirements, user stories, and test scenarios • Proficiency with MS Office, JIRA/Azure DevOps (ADO), Visio, or similar tools • Excellent analytical, documentation, communication, and problem-solving skills • Preferred: Experience with Medicaid pharmacy programs, MMIS, or PBM systems • Preferred: Understanding of clinical and DUR rules, formulary management, rebates, and PA workflows • Preferred certifications: CBAP, PMI-PBA, Agile/Scrum, or Pharmacy Technician (CPhT) • Knowledge of CMS Medicaid regulations, including CMS 42 CFR Part 455, OUD policies, and CMS drug rebate programs • Video cameras must be used during all interviews and during the initial week of orientation

🏖️ Benefits

• Work flexibility • Learning and career development • Competitive compensation • Professional development opportunities • Flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies