Senior Professional Business Analyst - Pharmacy

Gainwell Technologies LLC

1d•$64,900 - $92,700•Remote

About The Position

As a Senior Professional 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. We are seeking a highly skilled professional with strong experience in Pharmacy operations and Prior Authorization (PA) processes to support the configuration of automated PA rules within the PAE and Agadia platforms. The ideal candidate will possess a deep understanding of how pharmacy Prior Authorizations are initiated, reviewed, and adjudicated, and will be able to translate that knowledge into accurate rule configuration and workflow design. Play a critical part in ensuring Gainwell is meeting our clients’ objectives in pharmacy benefit management (PBM) services.

Requirements

Six (6) or more years of experience in a relevant pharmacy business analyst or pharmacy technician position with 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
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
Advanced knowledge in analytical software such as Microsoft Excel or SQL and other requirement-mapping tools such as Application Lifecycle Management (ALM) tools
Strong client communication skills translating client needs to actionable objectives
Strong analytical and business process re-engineering skills
Strong executive presence and communication skills to deliver messages to business leaders, clients and technical personnel
Good organization skills to balance work and prioritize tasks
Ability to work independently with minimal supervision

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