Senior Business Analyst - Pharmacy

Gainwell Technologies provides technology solutions that help healthcare clients improve the health and well-being of the members they serve. The Senior Business Analyst - Pharmacy supports pharmacy benefit management services by leading implementations, configurations, operations, requirements analysis, process improvements, and testing for pharmacy payer systems.

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 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
• 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