Business Analyst - Pharmacy IT
$51,900–$74,200 year
RemoteUnited States
Job Summary
Gather, document, and validate business, functional, and technical requirements for pharmacy IT systems, including POS, DUR, claims processing, and Preferred Drug Lists. Translate CMS, Medicaid, and rebate program updates into system requirements while collaborating with stakeholders, pharmacists, and IT teams. Analyze pharmacy claims processing, NCPDP standards, pricing methodologies, and drug file updates to support system design for prior authorization workflows and formulary management. Develop use cases, workflows, and data mappings; create test plans and scripts for system enhancements. Conduct UAT, regression testing, and validation activities, documenting defects and coordinating resolution efforts. Support project planning, sprint activities, and release cycles by preparing status reports and facilitating stakeholder review sessions. Monitor pharmacy program policies and regulatory changes to assess system impacts. This role bridges business needs and technical solutions within Gainwell's mission-driven support for state Medicaid and public health programs.
Required Qualifications
- 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
- Bachelor's degree in Business, Healthcare, Information Systems, Pharmacy, or related field, English major preferred
Desired Qualifications
- 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)
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