Business Analyst with Pharmacy Claims

Title: Business Analyst/ Pharmacy Claims

Location: Remote

Type of Hire: Contract

Job Description:

We are seeking an experienced Business Analyst to support ahigh-priority initiative to upgrade pharmacy claims processing systems from NCPDP Version D.0 to F6. The Business Analyst will partner with business stakeholders, pharmacy operations, compliance teams, and IT development teams to analyze current-state processes, document business and functional requirements, support testing activities, and ensure successful implementation of the new NCPDP F6 standard on the IBM i (AS/400) platform.

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Key Responsibilities:

• Lead business analysis activities for migration from NCPDP D.0 to F6.

• Gather, analyze, document, and validate business, functional, and non-functional requirements.

• Conduct stakeholder interviews, workshops, and requirements sessions with business users, pharmacy operations, compliance teams, and IT.

• Analyze existing IBM i (AS/400) applications, DB2database structures, interfaces, reports, and business workflows to identify impacts of the F6 conversion.

• Review existing RPG/RPGLE application functionality with development teams to understand current business processes and document required enhancements.

• Create and maintain Business Requirements Documents (BRDs), Functional Requirements Documents (FRDs), process flows, use cases, user stories, acceptance criteria, and data mapping documents.

• Perform end-to-end impact analysis across pharmacy claims processing, eligibility, billing, adjudication, reporting, and downstream integrations.

• Collaborate closely with developers, architects, QA, and business stakeholders throughout the Software Development Life Cycle(SDLC).

• Develop test scenarios, review test cases, support System Integration Testing (SIT), User Acceptance Testing (UAT), and defect resolution.

• Validate data using SQL and DB2 queries to support testing and business verification.

• Ensure all business requirements comply with NCPDPF6 standards and applicable healthcare regulations.

• Support implementation planning, production deployment, and post-production validation.

• Assist with change management, business readiness, and end-user documentation.

Required Skills:

• 8 years of Business Analyst experience supporting enterprise application development projects.

• Hands-on experience working with IBM i (AS/400) applications.

• Strong understanding of DB2 for i (DB2/400) database structures and data analysis.

• Experience performing impact analysis on legacy IBM i applications.

• Ability to understand RPG/RPGLE application logic sufficiently to translate business requirements into functional specifications.

• Experience writing SQL queries for data analysis and validation.

• Familiarity with APIs, file interfaces, EDI transactions, and batch processing.

• Experience supporting Agile, Scrum, or Waterfall methodologies.