Professional Business Analyst

Gainwell Technologies LLC is a leader in healthcare IT, dedicated to improving health outcomes through technology solutions. As a Professional Business Analyst, you will deliver high-impact Medicaid and public health technology solutions, bridging business needs and technical solutions while supporting pharmacy benefit management and operational efficiency.

Responsibilities:

• Gather, document, and validate business, functional, and technical requirements for pharmacy IT systems (e.g., POS, DUR, pharmacy claims processing, RTBT, Preferred Drug Lists)
• Translate regulatory and policy updates (CMS, Medicaid pharmacy rules, rebate programs) into system impacts and requirements
• Work closely with business stakeholders, pharmacists, SMEs, and IT teams to define scope and acceptance criteria
• Analyze pharmacy claims processing logic, NCPDP standards, pricing and reimbursement methodologies, and drug file updates
• Assist in system design relating to DUR, PA workflow, clinical edits, drug coverage modules, formulary management, and rebate processing
• Create and update use cases, data mappings, workflows, and system configuration documentation
• Develop test plans, scenarios, and scripts for pharmacy-related system enhancements
• Perform UAT, regression testing, and validation of changes to pharmacy modules
• Document defects, work with technical teams to resolve issues, and confirm results meet requirements
• Support project planning, sprint activities, and cross-functional coordination for release cycles
• Provide regular updates, prepare business/technical documentation, and contribute to status reports
• Facilitate meetings, requirement workshops, and stakeholder reviews
• Monitor and interpret pharmacy program policies, CMS guidelines, and regulatory changes for system impact
• Support operational teams in analyzing claim issues, pricing discrepancies, and pharmacy provider concerns
• Assist in audit support, documentation, and compliance-driven deliverables

Requirements:

• 3+ years of experience in business analysis within healthcare or pharmacy IT environments
• Bachelor's degree in Business, Healthcare, Information Systems, Pharmacy, or related field
• Strong understanding of pharmacy benefit management operations and terminology
• Experience writing business requirements, user stories, and test scenarios
• Proficiency with MS Office, JIRA/Azure DevOps (ADO), Visio, or similar tools
• Excellent analytical, documentation, communication, and problem-solving skills
• Familiarity with NCPDP standards, pharmacy claims processing, drug file management (Medi-Span/First Databank), and pricing methodologies
• Experience with Medicaid pharmacy programs, MMIS, or PBM systems
• Understanding of Clinical and DUR rules, formulary management, rebates, and PA workflows
• Certification(s): CBAP, PMI-PBA, Agile/Scrum, or Pharmacy Technician (CPhT)
• Knowledge of CMS Medicaid regulations (e.g., CMS 42 CFR Part 455, OUD policies, CMS drug rebate programs)