Gainwell Technologies · 5 hours ago
Senior Business Analyst - Pharmacy IT
United States
Full-time
Remote
Senior Level
5+ years expGainwell Technologies delivers high-impact Medicaid and public health technology solutions to improve health outcomes and operational efficiency. The Senior Business Analyst - Pharmacy IT plays a key role in supporting pharmacy benefit management programs and ensuring accurate delivery of pharmacy services and claims processing capabilities.
Health CareInformation Technology
Responsibilities
Gather, document, and validate business, functional, and technical requirements for pharmacy IT systems (e.g., POS, DUR, pharmacy claims processing, RTBT, Preferred Drug Lists)
Translate regulatory and policy updates (CMS, Medicaid pharmacy rules, rebate programs) into system impacts and requirements
Work closely with business stakeholders, pharmacists, SMEs, and IT teams to define scope and acceptance criteria
Analyze pharmacy claims processing logic, NCPDP standards, pricing and reimbursement methodologies, and drug file updates
Assist in system design relating to DUR, PA workflow, clinical edits, drug coverage modules, formulary management, and rebate processing
Create and update use cases, data mappings, workflows, and system configuration documentation
Develop test plans, scenarios, and scripts for pharmacy-related system enhancements
Perform UAT, regression testing, and validation of changes to pharmacy modules
Document defects, work with technical teams to resolve issues, and confirm results meet requirements
Support project planning, sprint activities, and cross-functional coordination for release cycles
Provide regular updates, prepare business/technical documentation, and contribute to status reports
Facilitate meetings, requirement workshops, and stakeholder reviews
Monitor and interpret pharmacy program policies, CMS guidelines, and regulatory changes for system impact
Support operational teams in analyzing claim issues, pricing discrepancies, and pharmacy provider concerns
Assist in audit support, documentation, and compliance-driven deliverables
Qualification
Required
Bachelor's degree in Business, Healthcare, Information Systems, Pharmacy, or related field
5+ years of experience in business analysis within healthcare or pharmacy IT environments
Strong understanding of pharmacy benefit management operations and terminology
Familiarity with NCPDP standards, pharmacy claims processing, drug file management (Medi-Span/First Databank), and pricing methodologies
Experience writing business requirements, user stories, and test scenarios
Proficiency with MS Office, JIRA/Azure DevOps (ADO), Visio, or similar tools
Excellent analytical, documentation, communication, and problem-solving skills
Preferred
Experience with Medicaid pharmacy programs, MMIS, or PBM systems
Understanding of Clinical and DUR rules, formulary management, rebates, and PA workflows
Certification(s): CBAP, PMI-PBA, Agile/Scrum, or Pharmacy Technician (CPhT)
Knowledge of CMS Medicaid regulations (e.g., CMS 42 CFR Part 455, OUD policies, CMS drug rebate programs)
Ability to write and execute SQL queries
Benefits
Competitive compensation
Benefits
Professional development opportunities
Company
Gainwell Technologies
Gainwell Technologies is a provider of Information Technology & Services. It is a sub-organization of Veritas Capital.
10001+ employees
H1B Sponsorship
Gainwell Technologies has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (66)
2024 (78)
2023 (56)
2022 (96)
2021 (33)
Funding
Current Stage
Late StageTotal Funding
$1M2023-06-06Grant· $1M
Leadership Team
Paul N. Saleh
President and Chief Executive Officer
Gary Call
Chief Medical Officer
Recent News
bloomberglaw.com
2025-12-12
GlobeNewswire
2025-12-11
Company data provided by crunchbase