Senior Business Analyst – Pharmacy

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

📋 Description

• Play an essential role in ensuring Gainwell meets the objectives of our clients in pharmacy benefit management (PBM) services.

• Assist in the implementation and configuration of PBM or drug rebate systems.

• Support the operations and maintenance of established PBM accounts.

• Collaborate with a team of pharmacy clinicians and subject matter experts to set up pharmacy systems that deliver services to our state clients.

• Aid in the implementation of a pharmacy payer system.

• Conduct pharmacy updates, including benefit plan design, edit/audit setup, utilization controls, PDL, configuration updates, and auto prior authorization parameters.

• Serve as an informed liaison among operations staff, clients, project managers, and technical staff to define, document, and communicate pharmacy business requirements and their expected impacts.

• Work closely with clients to develop business rules and configuration requirements.

• Analyze, plan, design, document, or provide recommendations to enhance business processes that support the technology goals of clients.

• Ensure that all requirements are met by approving and validating test results.

• Conduct testing of point of sale (POS) pharmacy claims as necessary.

• Utilize basic analytical or relational database software—such as Excel or SQL—to quantify the anticipated impact of your work.

⛳️ Requirements

• A minimum of six (6) years of experience in a relevant role as a pharmacy business analyst or pharmacy technician, with at least three years of experience in Medicaid and Medicare preferred.

• Understanding of computer programming concepts such as configuration, development, data conversion analysis, and batch processing.

• Extensive knowledge of analytical software like Microsoft Excel or SQL, as well as other requirement-mapping tools such as Application Lifecycle Management (ALM) tools.

• Excellent communication skills, including the ability to translate client needs into actionable objectives and present effectively to business, technical, and executive audiences.

• Strong analytical skills, with experience in business process re-engineering and problem-solving.

• Highly organized, capable of prioritizing tasks, managing workloads effectively, and working independently.

• Experience in pharmacy as a Pharmacy Technician or in a PBM environment.

• Familiarity with drugs and drug file structures through FDB, Medispan, or Micromedex.

• Understanding of the pharmacy payer process and claims processing.

• Experience with drug file data or NCPDP guidelines.

• Preferred knowledge of prior authorization processes and criteria.

🏝️ Benefits

• Health benefits

• Flexible vacation policy

• Educational assistance

• Leadership and technical development academies