Business Analyst – Pharmacy IT

This is a fully remote position, open to applicants in United States.

📋 Description

• Collect, document, and verify business, functional, and technical requirements for pharmacy IT systems, encompassing POS, DUR, claims processing, RTBT, and Preferred Drug Lists.

• Convert CMS, Medicaid, and rebate program updates into business and system requirements.

• Work alongside stakeholders, pharmacists, SMEs, and IT teams to outline scope, requirements, and acceptance criteria.

• Examine pharmacy claims processing, NCPDP standards, pricing and reimbursement methodologies, and drug file updates.

• Assist in system design for DUR, prior authorization workflows, clinical edits, drug coverage, formulary management, and rebate processing.

• Create and sustain use cases, workflows, data mappings, and configuration documentation.

• Develop test plans, scenarios, and scripts for enhancements within the pharmacy system.

• Execute UAT, regression testing, and validation processes.

• Record defects, coordinate resolution efforts, and confirm that outcomes meet established requirements.

• Aid in project planning, sprint activities, release cycles, and cross-functional collaboration.

• Generate status reports, business documentation, and communications for stakeholders.

• Lead requirements workshops, meetings, and sessions for stakeholder reviews.

• Monitor pharmacy program policies, CMS guidance, and regulatory changes to evaluate system impacts.

• Support operational teams with claims issues, reimbursement discrepancies, and provider concerns.

• Facilitate audits, compliance initiatives, and necessary documentation deliverables.

⛳️ Requirements

• Bachelor’s degree in Business, Healthcare, Information Systems, Pharmacy, or a related field.

• Over 2 years of experience in business analysis.

• Strong comprehension of pharmacy benefit management operations and terminology.

• Familiarity with NCPDP standards, pharmacy claims processing, drug file management (Medi-Span/First Databank), and pricing methodologies.

• Experience in drafting business requirements, user stories, and test scenarios.

• Proficient in MS Office, JIRA/Azure DevOps (ADO), Visio, or similar software.

• Exceptional analytical, documentation, communication, and problem-solving abilities.

• Preferred: Experience with Medicaid pharmacy programs, MMIS, or PBM systems.

• Preferred: Knowledge of clinical and DUR rules, formulary management, rebates, and PA workflows.

• Preferred certifications: CBAP, PMI-PBA, Agile/Scrum, or Pharmacy Technician (CPhT).

• Understanding of CMS Medicaid regulations, including CMS 42 CFR Part 455, OUD policies, and CMS drug rebate programs.

• Video cameras must be utilized during all interviews and throughout the initial week of orientation.

🏝️ Benefits

• Flexible work arrangements.

• Opportunities for learning and career advancement.

• Competitive salary.

• Professional development opportunities.

• Flexible vacation policy.

• 401(k) employer match.

• Comprehensive health benefits.

• Educational assistance.

• Leadership and technical development academies.