Senior Business Analyst - Pharmacy

Gainwell Technologies LLC•Any city, OH

3d•$69,400 - $99,200•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. Your role in our mission Play 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 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

Six (6) or more years of experience in a relevant pharmacy business analyst or pharmacy technician position
3 or more years of Medicaid and Medicare experience preferred
Knowledge of computer programming concepts such as configuration, development, data conversion analysis and batch processing
Advanced knowledge in analytical software such as Microsoft Excel or SQL and other requirement-mapping tools such as Application Lifecycle Management (ALM) tools
Strong communication skills, including translating client needs into actionable objectives and presenting effectively to business, technical, and executive audiences
Strong analytical abilities with experience in business process re-engineering and problem solving
Highly organized with the ability to prioritize tasks, manage workload effectively, and operate independently

Nice To Haves

Knowledge of prior authorization processes and criteria preferred

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