Business Analyst - NCPDP

Gainwell Technologies is a company dedicated to improving health and well-being through innovative technology solutions. As a Business Analyst - NCPDP, you will analyze and improve business processes, facilitate communication between clients and technical teams, and ensure compliance through regular audits and documentation.

Responsibilities:

• Analyze, plan, design, document and make recommendations to improve business processes to support client’s technological aspirations
• Be a supportive bridge between clients, project managers and technical personnel to define, track and communicate business requirements and their expected impact by building basic conceptual data and process models
• Create, execute or analyze basic test scenarios to verify that client requirements are built into system design
• Ensure that “intent of change” is carried out through every project phase by participating in technical reviews and inspections
• Conduct regular audits of business processes, policy documentation, and operational workflows to ensure compliance with internal standards and regulatory requirements
• Review and validate policy implementation across departments, identifying inconsistencies, risks, and areas for improvement
• Develop audit plans, checklists, and methodologies to support consistent and repeatable audit practices
• Document audit findings and prepare clear, actionable reports for leadership and stakeholders
• Analyze, estimate, design, document, and implement configurable policy-based system updates in the Claims, Reference Data Maintenance, and Business Policy Administration (BPA) functional areas
• Experience with all four claim forms: Physician, Institutional, Dental, and Pharmacy
• Experience with member benefit plan configuration updates
• Experience solutioning and creating new system functionality to audit / deny claims based on client’s needs
• Implement quarterly code set updates, adding coverage/reimbursement rules and updating state specific service restrictions for all procedure, revenue, NDC/GSN/STC code types

Requirements:

• Three or more years of Business Analysis experience in Healthcare industry translating technical goals and requirements into real action for clients
• Understanding of NCPDP standards
• Experience with EDI processing, pharmacy claims and Medicaid Management Information Systems (MMIS)
• Familiar with system design, solutioning, configuration, and testing phases
• Facilitates meetings with clients to gather and document requirements and secure design sign-off as needed
• Creating, documenting, and presenting system test plans/scenarios to the client
• Knowledge of basic computer programming concepts such as configuration, development and batch processing
• Advanced knowledge of Microsoft Excel and other software for conducting quantitative analysis
• Strong analytical and business process re-engineering skills
• Strong written and oral communication and presentation skills to deliver messages to business leaders, clients and technical personnel
• An influencer and team player who motivates others to action and communicates key technical ideas in a digestible way
• Conduct regular audits of business processes, policy documentation, and operational workflows to ensure compliance with internal standards and regulatory requirements
• Review and validate policy implementation across departments, identifying inconsistencies, risks, and areas for improvement
• Develop audit plans, checklists, and methodologies to support consistent and repeatable audit practices
• Document audit findings and prepare clear, actionable reports for leadership and stakeholders
• Familiar with audit frameworks, risk management principles, or quality assurance methodologies
• Analyze, estimate, design, document, and implement configurable policy-based system updates in the Claims, Reference Data Maintenance, and Business Policy Administration (BPA) functional areas
• Experience with all four claim forms: Physician, Institutional, Dental, and Pharmacy
• Experience with member benefit plan configuration updates
• Experience solutioning and creating new system functionality to audit / deny claims based on client's needs
• Implement quarterly code set updates, adding coverage/reimbursement rules and updating state specific service restrictions for all procedure, revenue, NDC/GSN/STC code types