Business Analyst - NCPDP

Gainwell Technologies LLC

5h•Remote

About The Position

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities. SummaryAs a Business Analyst - NCPDP at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position.Your role in our missionGainwell empowers you show you’re a pro and help clients deliver better health and human services outcomes using innovative technology and solutions.

Requirements

Three or more years of Business Analysis experience in Healthcare industry translating technical goals and requirements into real action for clients
Understanding of NCPDP standards
Experience with EDI processing, pharmacy claims and Medicaid Management Information Systems (MMIS).
Familiar with system design, solutioning, configuration, and testing phases.
Facilitates meetings with clients to gather and document requirements and secure design sign-off as needed.
Creating, documenting, and presenting system test plans/scenarios to the client.
Knowledge of basic computer programming concepts such as configuration, development and batch processing
Advanced knowledge of Microsoft Excel and other software for conducting quantitative analysis
Strong analytical and business process re-engineering skills
Strong written and oral communication and presentation skills to deliver messages to business leaders, clients and technical personnel
An influencer and team player who motivates others to action and communicates key technical ideas in a digestible way
Familiar with audit frameworks, risk management principles, or quality assurance methodologies.
Experience with all four claim forms: Physician, Institutional, Dental, and Pharmacy.
Experience with member benefit plan configuration updates
Experience solutioning and creating new system functionality to audit / deny claims based on client’s needs.

Responsibilities

Analyze, plan, design, document and make recommendations to improve business processes to support client’s technological aspirations
Be a supportive bridge between clients, project managers and technical personnel to define, track and communicate business requirements and their expected impact by building basic conceptual data and process models
Create, execute or analyze basic test scenarios to verify that client requirements are built into system design
Ensure that “intent of change” is carried out through every project phase by participating in technical reviews and inspections
Conduct regular audits of business processes, policy documentation, and operational workflows to ensure compliance with internal standards and regulatory requirements.
Review and validate policy implementation across departments, identifying inconsistencies, risks, and areas for improvement.
Develop audit plans, checklists, and methodologies to support consistent and repeatable audit practices.
Document audit findings and prepare clear, actionable reports for leadership and stakeholders.
Analyze, estimate, design, document, and implement configurable policy-based system updates in the Claims, Reference Data Maintenance, and Business Policy Administration (BPA) functional areas.
Implement quarterly code set updates, adding coverage/reimbursement rules and updating state specific service restrictions for all procedure, revenue, NDC/GSN/STC code types.