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 The
Business Analyst - Pharmacy IT plays a key role in supporting pharmacy benefit management (PBM) programs, Medicaid pharmacy operations, and pharmacy IT solution delivery. This role bridges business needs and technical solutions-analyzing requirements, enhancing pharmacy systems, supporting compliance, and ensuring accurate delivery of pharmacy services and claims processing capabilities.
Why Gainwell - Mission-driven work supporting state Medicaid and public health programs.
- Collaborative environment with growth opportunities in pharmacy IT and healthcare analytics.
- Competitive compensation, benefits, and professional development opportunities
Your role in our mission - Gather, document, and validate business, functional, and technical requirements for pharmacy IT systems, including POS, DUR, claims processing, RTBT, and Preferred Drug Lists.
- Translate CMS, Medicaid, and rebate program updates into business and system requirements.
- Collaborate with stakeholders, pharmacists, SMEs, and IT teams to define scope, requirements, and acceptance criteria.
- Analyze pharmacy claims processing, NCPDP standards, pricing and reimbursement methodologies, and drug file updates.
- Support system design for DUR, prior authorization workflows, clinical edits, drug coverage, formulary management, and rebate processing.
- Develop and maintain use cases, workflows, data mappings, and configuration documentation.
- Create test plans, scenarios, and scripts for pharmacy system enhancements.
- Conduct UAT, regression testing, and validation activities.
- Document defects, coordinate resolution efforts, and verify outcomes meet requirements.
- Support project planning, sprint activities, release cycles, and cross-functional coordination.
- Prepare status reports, business documentation, and stakeholder communications.
- Facilitate requirements workshops, meetings, and stakeholder review sessions.
- Monitor pharmacy program policies, CMS guidance, and regulatory changes to assess system impacts.
- Assist operational teams with claims issues, reimbursement discrepancies, and provider concerns.
- Support audits, compliance initiatives, and required documentation deliverables.
What we're looking for - Bachelor's degree in Business, Healthcare, Information Systems, Pharmacy, or related field.
- 2+ years of experience in business analysis.
- 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 Qualifications - 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).
What you should expect in this role - Fully remote opportunity from most US locations
- 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 August 20, 2026.
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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. Gainwell Technologies defines "wages" and "wage rates" to include "all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.
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