Business Analyst - Pharmacy IT

Gainwell Technologies LLC•Any city, OH

1d•$51,900 - $74,200•Remote

About The Position

The Business Analyst - Pharmacy IT plays a key role in supporting pharmacy benefit management (PBM) programs, Medicaid pharmacy operations, and pharmacy IT solution delivery. This role bridges business needs and technical solutions—analyzing requirements, enhancing pharmacy systems, supporting compliance, and ensuring accurate delivery of pharmacy services and claims processing capabilities.

Requirements

Bachelor’s degree in Business, Healthcare, Information Systems, Pharmacy, or related field.
2+ years of experience in business analysis.
Strong understanding 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 writing business requirements, user stories, and test scenarios.
Proficiency with MS Office, JIRA/Azure DevOps (ADO), Visio, or similar tools.
Excellent analytical, documentation, communication, and problem-solving skills.

Nice To Haves

Experience with Medicaid pharmacy programs, MMIS, or PBM systems.
Understanding of Clinical and DUR rules, formulary management, rebates, and PA workflows.
Certification(s): CBAP, PMI-PBA, Agile/Scrum, or Pharmacy Technician (CPhT).
Knowledge of CMS Medicaid regulations (e.g., CMS 42 CFR Part 455, OUD policies, CMS drug rebate programs).

Responsibilities

Gather, document, and validate business, functional, and technical requirements for pharmacy IT systems, including POS, DUR, claims processing, RTBT, and Preferred Drug Lists.
Translate CMS, Medicaid, and rebate program updates into business and system requirements.
Collaborate with stakeholders, pharmacists, SMEs, and IT teams to define scope, requirements, and acceptance criteria.
Analyze pharmacy claims processing, NCPDP standards, pricing and reimbursement methodologies, and drug file updates.
Support system design for DUR, prior authorization workflows, clinical edits, drug coverage, formulary management, and rebate processing.
Develop and maintain use cases, workflows, data mappings, and configuration documentation.
Create test plans, scenarios, and scripts for pharmacy system enhancements.
Conduct UAT, regression testing, and validation activities.
Document defects, coordinate resolution efforts, and verify outcomes meet requirements.
Support project planning, sprint activities, release cycles, and cross-functional coordination.
Prepare status reports, business documentation, and stakeholder communications.
Facilitate requirements workshops, meetings, and stakeholder review sessions.
Monitor pharmacy program policies, CMS guidance, and regulatory changes to assess system impacts.
Assist operational teams with claims issues, reimbursement discrepancies, and provider concerns.
Support audits, compliance initiatives, and required documentation deliverables.