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 Job! Apply to this Job