Gainwell TechnologiesRemote
Senior Business Analyst - Pharmacy Job Details | Gainwell Technologies LLC
United States of America
Full Time
1 week ago
$69,000 - $99,000 USD
H1B Sponsor Likely
Key skills
Pharmacy Benefit Management (PBM)Drug Rebate ImplementationPharmacy Systems ConfigurationPharmacy Payer System ImplementationPharmacy Benefit Plan DesignPharmacy Claims ProcessingPrior Authorization ProcessesMedicaid and Medicare ProgramsPharmacy Technician ExperienceFDB Drug File KnowledgeMedispan Drug File KnowledgeMicromedex Drug File KnowledgeNCPDP GuidelinesMicrosoft ExcelSQLApplication Lifecycle Management (ALM) ToolsCommunicationProblem Solving
About this role
Gainwell Technologies is dedicated to improving the health and well-being of vulnerable communities through technology. As a Senior Business Analyst - Pharmacy, you will play a critical role in pharmacy benefit management, ensuring client objectives are met by supporting implementations, operations, and system configurations.
Responsibilities:
- 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
- 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
- 3 or more years of Medicaid and Medicare experience preferred
- Knowledge of prior authorization processes and criteria preferred