Senior Business Analyst – Pharmacy Claims

🕒 4 days ago

🇺🇸 United States – Remote

💵 $64.9k - $92.7k / year

⏰ Full Time

🟠 Senior

🧐 Business Analyst

🦅 H1B Visa Sponsor

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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

• Support PBM or drug rebate implementations and configurations • Support PBM operations and maintenance on established accounts • Work with pharmacy clinicians and subject matter experts to configure pharmacy systems for 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 impacts with operations staff, clients, project managers, and technical staff • Develop business rules and configuration requirements with clients • Analyze, plan, design, document, or recommend business process improvements supporting client technology goals • Verify requirements by approving and validating test results • Use Excel or SQL and basic analytical or relational database software to quantify anticipated work impact

🎯 Requirements

• 6+ years of experience in pharmacy operations, business analysis, or pharmacy technician roles • Preferred expertise in Medicaid and Medicare programs • Strong understanding of pharmacy claims processing, payer systems, prior authorization workflows, and NCPDP standards • Experience testing point-of-sale (POS) pharmacy claims • Experience with drug databases and file structures, including FDB, Medi-Span, and Micromedex • Advanced analytical and technical skills, including Excel, SQL, data analysis, requirements mapping, and system configuration concepts • Ability to solve complex business problems, improve processes, manage priorities independently, and communicate effectively with business, technical, and executive stakeholders • Video cameras must be used during all interviews and the initial week of orientation

🏖️ Benefits

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