Pharmacy Business Analyst - Conversion & Prior Auth SME

Date: Jul 16, 2025

Location:

Any city, MO, US, 99999

Req ID: 31743

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development.

Summary

As a Pharmacy Business Analyst - Conversion & Prior Auth SME 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. Here are the details on this position.

Your role in our mission

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

What we're looking for

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 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

Skills and Compentencies

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

What you should expect in this role

Fully remote options from continental US locations only
Video cameras must be used during all interviews, as well as during the initial week of orientation
The deadline to submit applications for this posting is July 29, 2025
#LI-HC1
#LI-Pharmacy Technician
#LI-SQL

The pay range for this position is $51,900.00 - $74,200.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.