Pharmacy Business Analyst - Conversion & Prior Auth SME
- Description:
- 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:
- Three (3) or more years of experience in a relevant pharmacy business analyst or pharmacy technician position with 1+ 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 of 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
- Benefits:
- generous, flexible vacation policy
- 401(k) employer match
- comprehensive health benefits
- educational assistance
- leadership and technical development academies
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