Senior Business Analyst - Pharmacy

Role Description

As a Senior Business Analyst - Pharmacy at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Here are the details on this position:

• 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.

Qualifications

• 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.

Requirements

• 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

• Generous, flexible vacation policy.
• 401(k) employer match.
• Comprehensive health benefits.
• Educational assistance.
• Leadership and technical development academies to help build your skills and capabilities.