Pharmacy Business Operations Analyst (Remote)

University Hospitals•Warrensville Heights, OH

1d•Remote

About The Position

The Pharmacy Business Operations Analyst is responsible for monitoring, analyzing, and improving pharmacy business operations processes with a focus on claim-level workflows, financial reconciliation, and operational effectiveness. The analyst supports day-to-day execution while also identifying trends, surfacing risks, and driving process improvements. The position will initially focus on workflows related to manufacturer pricing programs and Medicare initiatives (including Maximum Fair Price program operations), with flexibility to expand into broader pharmacy revenue integrity and reimbursement functions over time.

Requirements

Bachelor's Degree healthcare administration, business, pharmacy, or related field (Required) or equivalent experience may be considered (Preferred)
1+ years experience in pharmacy operations, reimbursement, 340B operations or payment reconciliation (Required)
Experience working with detailed data, including claim-level or transaction-level review (Required)
Strong analytical and problem-solving skills with attention to detail (Required)
Experience with healthcare or pharmacy claims or payment workflows (Required)
Ability to manage multiple priorities in a fast-paced, deadline-driven environment (Required proficiency)
Proficiency in Excel (e.g., large datasets, pivot tables, data analysis) (Required proficiency)
Demonstrated ownership mindset and ability to work independently (Required proficiency)

Nice To Haves

Familiarity with 340B operations or manufacturer program processes (Preferred)
Experience with business intelligence tools (e.g., Power BI, Tableau) (Preferred)
Exposure to SQL or other data querying tools (Preferred)
Experience with workflow or case management systems (e.g., Beacon or similar platforms) (Preferred)
Knowledge of pharmacy systems, reimbursement models, or regulatory programs (Preferred)
Strong written and verbal communication skills (Preferred proficiency)
Financial reconciliation and variance analysis (Preferred proficiency)
Strong documentation discipline and ability to manage high-volume operational work with short turnaround expectations (Preferred proficiency)
Operational analytics and process improvement (Preferred proficiency)
Data validation and reporting (Preferred proficiency)
Cross-functional collaboration and stakeholder management (Preferred proficiency)
Problem-solving and critical thinking (Preferred proficiency)
Process ownership and accountability (Preferred proficiency)
Adaptability in a dynamic regulatory and operational environment (Preferred proficiency)

Responsibilities

Monitor and manage operational workflows including claim queues, aging, and status tracking to ensure timely processing and resolution
Review and validate claim-level data for accuracy, completeness, and readiness for submission or follow-up
Track and investigate discrepancies between internal findings and external determinations (e.g., manufacturer or platform outcomes)
Partner cross-functionally with pharmacy operations, finance, 340B, revenue cycle, and analytics teams to resolve issues and improve workflows
Maintain issue logs for disputed claims, payment delays, data mismatches, and manufacturer-specific recurring issues
Perform financial reconciliation of expected versus actual payments, credits, and adjustments; escalate and resolve variances
Develop and maintain reporting on key metrics such as volume, aging, turnaround times, financial impact, and dollars at risk
Support development and maintenance of standard operating procedures, documentation, and control frameworks
Support annual readiness planning as additional negotiated drugs enter the MFP program
Analyze trends in claims, payments, and operational performance; provide actionable insights and recommendations
Contribute to ongoing process optimization and scalability initiatives across pharmacy business operations
Assist in readiness planning and implementation of new programs, policies, and regulatory requirements
Performs other duties as assigned.
Complies with all policies and standards.
Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.