Senior Business Analyst – Pharmacy

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

📋 Description

• Ensure that Gainwell fulfills its clients' goals in pharmacy benefit management (PBM) services.

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

• Support the operations and maintenance of PBM for established accounts.

• Collaborate with pharmacy clinicians and subject matter experts to set up pharmacy systems for state clients.

• Aid in the rollout of a pharmacy payer system.

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

• Define, document, and communicate pharmacy business requirements and anticipated impacts among operations personnel, clients, project managers, and technical teams.

• Partner with clients to create business rules and configuration needs.

• Evaluate, plan, design, document, or propose enhancements to business processes that align with clients' technology objectives.

• Validate requirements by approving and confirming test outcomes.

• Test point-of-sale (POS) pharmacy claims as necessary.

• Utilize Excel or SQL to assess the expected impact of work.

⛳️ Requirements

• A minimum of six (6) years of experience in a relevant pharmacy business analyst or pharmacy technician role.

• At least three (3) years of experience with Medicaid and Medicare is preferred.

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

• Advanced proficiency in Microsoft Excel or SQL, as well as requirement-mapping tools like Application Lifecycle Management (ALM) tools.

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

• Strong analytical skills with a background in business process re-engineering and problem-solving.

• Highly organized with the capacity to prioritize tasks, manage workload efficiently, and work independently.

• Experience in the pharmacy field as a Pharmacy Technician or with a PBM.

• Knowledge of drugs and drug file structures through sources like FDB, Medispan, or Micromedex.

• Understanding of the pharmacy payer process and claims processing.

• Experience with drug file data or NCPDP guidelines.

• Familiarity with prior authorization processes and criteria is preferred.

• Video cameras are required to be used during all interviews and throughout the first week of orientation.

🏝️ Benefits

• Flexibility in work arrangements.

• Opportunities for learning and career advancement.

• Generous and flexible vacation policy.

• Employer-matched 401(k).

• Comprehensive health benefits.

• Educational assistance.

• Leadership and technical development academies.

• Up to 10% travel for client meetings, requirement reviews, or implementations.