Senior Professional Business Analyst - Pharmacy

Summary

As a Senior Professional Business Analyst - Pharmacy 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.

We are seeking a highly skilled professional with strong experience in Pharmacy operations and Prior Authorization (PA) processes to support the configuration of automated PA rules within the PAE and Agadia platforms. The ideal candidate will possess a deep understanding of how pharmacy Prior Authorizations are initiated, reviewed, and adjudicated, and will be able to translate that knowledge into accurate rule configuration and workflow design.

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 

.... your role continued

• 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

• Six (6) or more years of experience in a relevant pharmacy business analyst or pharmacy technician position with 3 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

Additional Skills

• Advanced knowledge in analytical software such as Microsoft Excel or SQL and other requirement-mapping tools such as Application Lifecycle Management (ALM) tools
• 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

• Remote opportunity from Continental US locations only
• Possibility of up to 10% travel for client meetings/requirement review or implementations
• 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 January 23, 2026

#LI-HC1

#LI-Pharmacy

#LI-PBM

#LI-NCPDP

#LI-Payer / Claims processing

#LI-POS testing