Pharmacy Business Operations Analyst (Remote)

University Hospitals is seeking a Pharmacy Business Operations Analyst to monitor, analyze, and improve pharmacy business operations processes. The role focuses on claim-level workflows, financial reconciliation, and operational effectiveness while supporting day-to-day execution and driving process improvements.

Responsibilities:

• Monitor and manage operational workflows including claim queues, aging, and status tracking to ensure timely processing and resolution
• Review and validate claim-level data for accuracy, completeness, and readiness for submission or follow-up
• Track and investigate discrepancies between internal findings and external determinations (e.g., manufacturer or platform outcomes)
• Partner cross-functionally with pharmacy operations, finance, 340B, revenue cycle, and analytics teams to resolve issues and improve workflows
• Maintain issue logs for disputed claims, payment delays, data mismatches, and manufacturer-specific recurring issues
• Perform financial reconciliation of expected versus actual payments, credits, and adjustments; escalate and resolve variances
• Develop and maintain reporting on key metrics such as volume, aging, turnaround times, financial impact, and dollars at risk
• Support development and maintenance of standard operating procedures, documentation, and control frameworks
• Support annual readiness planning as additional negotiated drugs enter the MFP program
• Analyze trends in claims, payments, and operational performance; provide actionable insights and recommendations
• Contribute to ongoing process optimization and scalability initiatives across pharmacy business operations
• Assist in readiness planning and implementation of new programs, policies, and regulatory requirements
• Performs other duties as assigned
• Complies with all policies and standards

Requirements:

• Bachelor's Degree healthcare administration, business, pharmacy, or related field
• 1+ years experience in pharmacy operations, reimbursement, 340B operations or payment reconciliation
• Experience working with detailed data, including claim-level or transaction-level review
• Strong analytical and problem-solving skills with attention to detail
• Experience with healthcare or pharmacy claims or payment workflows
• Ability to manage multiple priorities in a fast-paced, deadline-driven environment
• Proficiency in Excel (e.g., large datasets, pivot tables, data analysis)
• Demonstrated ownership mindset and ability to work independently
• equivalent experience may be considered
• Familiarity with 340B operations or manufacturer program processes
• Experience with business intelligence tools (e.g., Power BI, Tableau)
• Exposure to SQL or other data querying tools
• Experience with workflow or case management systems (e.g., Beacon or similar platforms)
• Knowledge of pharmacy systems, reimbursement models, or regulatory programs
• Strong written and verbal communication skills
• Financial reconciliation and variance analysis
• Strong documentation discipline and ability to manage high-volume operational work with short turnaround expectations
• Operational analytics and process improvement
• Data validation and reporting
• Cross-functional collaboration and stakeholder management
• Problem-solving and critical thinking
• Process ownership and accountability
• Adaptability in a dynamic regulatory and operational environment