Business Analyst - Pharmacy

Gainwell Technologies LLC

1d•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 - Pharmacy 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. The ideal candidate will have a strong background in pharmacy operations, with hands-on experience supporting pharmacy claims processing, drug reference/formulary management, drug rebate programs, and/or prior authorization workflows. Experience within a health plan, PBM, or Medicaid environment is highly preferred, with demonstrated ability to support operational, analytical, or configuration-related pharmacy functions Here are the details on this position.Your role in our missionPlay a critical part in ensuring Gainwell is meeting our clients’ objectives in pharmacy benefit management (PBM) services. Support PBM or Drug rebate implementations and configurations Support PBM operations and maintenance on established accounts Work with a team of pharmacy clinicians and subject matter experts to configure the pharmacy systems to deliver services to our state clients. Assist in implementation of a pharmacy payer system. Perform Pharmacy updates including benefit plan design, edit/audit set up, utilization controls, PDL, configuration updates, and auto prior authorization parameters Be a knowledgeable bridge between operations staff, clients, project managers and technical staff to define, document and share pharmacy business requirements and expected impact .... your role continued Work with the client to develop business rules and configuration requirements Analyze, plan, design, document or make recommendations to improve business processes to support client’s technology goals Help verify that all requirements have been met by approving and validating test results Testing point of sale (POS) pharmacy claims as required Exercise your ability to use basic analytical or relational database software — such as Excel or SQL — to quantify the anticipated impact of work

Requirements

Four (4) or more years of experience in a relevant pharmacy business analyst or pharmacy technician position with 2 or more years of Medicaid and Medicare experience preferred
Knowledge of computer programming concepts such as configuration, development, data conversion analysis and batch processing
Pharmacy Experience as a Pharmacy Technician or working for a PBM
Knowledge of drugs and drug file structures through FDB, Medispan, or Micromedex
Knowledge the pharmacy payer process/claims processing.
Experience working with drug file data or NCPDP guidelines
Knowledge of prior authorization processes and criteria preferred
Remote opportunity from Continental US locations only
Possibility of up to 10% travel for client meetings/requirement review or implementations
Video cameras must be used during all interviews, as well as during the initial week of orientation

Responsibilities

Support PBM or Drug rebate implementations and configurations
Support PBM operations and maintenance on established accounts
Work with a team of pharmacy clinicians and subject matter experts to configure the pharmacy systems to deliver services to our state clients.
Assist in implementation of a pharmacy payer system.
Perform Pharmacy updates including benefit plan design, edit/audit set up, utilization controls, PDL, configuration updates, and auto prior authorization parameters
Be a knowledgeable bridge between operations staff, clients, project managers and technical staff to define, document and share pharmacy business requirements and expected impact
Work with the client to develop business rules and configuration requirements
Analyze, plan, design, document or make recommendations to improve business processes to support client’s technology goals
Help verify that all requirements have been met by approving and validating test results
Testing point of sale (POS) pharmacy claims as required
Exercise your ability to use basic analytical or relational database software — such as Excel or SQL — to quantify the anticipated impact of work