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
Apply Now
Apply Now
• 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
Apply Now
Apply Now