Senior Business Analyst – Pharmacy

🔥 0 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $69.4k - $99.2k / year

⏰ Full Time

🟠 Senior

🧐 Business Analyst

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Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Healthcare Insurance • Human Services • Healthcare

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

• Play a critical part in ensuring Gainwell is meeting our clients’ objectives in pharmacy benefit management (PBM) services. • Support PBM or Drug rebate implementations and configurations • Support PBM operations and maintenance on established accounts • Work with a team of pharmacy clinicians and subject matter experts to configure the pharmacy systems to deliver services to our state clients. • Assist in implementation of a pharmacy payer system. • Perform Pharmacy updates including benefit plan design, edit/audit set up, utilization controls, PDL, configuration updates, and auto prior authorization parameters • Be a knowledgeable bridge between operations staff, clients, project managers and technical staff to define, document and share pharmacy business requirements and expected impact • Work with the client to develop business rules and configuration requirements • Analyze, plan, design, document or make recommendations to improve business processes to support client’s technology goals • Help verify that all requirements have been met by approving and validating test results • Testing point of sale (POS) pharmacy claims as required • Exercise your ability to use basic analytical or relational database software — such as Excel or SQL — to quantify the anticipated impact of work

🎯 Requirements

• Six (6) or more years of experience in a relevant pharmacy business analyst or pharmacy technician position with 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 in analytical software such as Microsoft Excel or SQL and other requirement-mapping tools such as Application Lifecycle Management (ALM) tools • Strong communication skills, including translating client needs into actionable objectives and presenting effectively 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 the pharmacy payer process/claims processing. • Experience working with drug file data or NCPDP guidelines • Knowledge of prior authorization processes and criteria preferred.

🏖️ Benefits

• Health benefits • Flexible vacation policy • Educational assistance • Leadership and technical development academies