Business Analyst- Pharmacy Systems

Overview

Remote
Hybrid
Depends on Experience
Contract - W2
Contract - Independent
Contract - 24 Month(s)

Skills

pharmacy
pbm

Job Details

We are seeking an experienced Business Analyst with strong knowledge of Pharmacy, PBM , and Healthcare systems. The ideal candidate will work closely with business stakeholders, product owners, and technical teams to gather, analyze, and translate requirements into actionable solutions that improve healthcare operations, pharmacy workflows, and PBM processes.

< data-start="743" data-end="774">Key Responsibilities</>

  • Collaborate with business stakeholders to gather and document requirements related to pharmacy services, PBM workflows, and healthcare operations.

  • Analyze existing systems, business processes, and data flows to identify gaps and opportunities for improvement.

  • Create BRDs (Business Requirement Documents), FRDs (Functional Requirement Documents), process flows, and user stories.

  • Support Medicare/Medicaid, commercial insurance, prior authorization, formulary management, specialty pharmacy, and claims adjudication initiatives.

  • Partner with product owners and technical teams to translate business needs into functional specifications.

  • Perform impact analysis for system changes and ensure compliance with HIPAA and healthcare regulations.

  • Work with QA teams to define test cases and validate system changes meet requirements.

  • Support implementation, UAT (User Acceptance Testing), and rollout of new products or enhancements.

  • Serve as a subject matter expert (SME) for pharmacy, PBM, and healthcare-related domains.

< data-start="1866" data-end="1900">Required Qualifications</>

  • Bachelor s degree in Healthcare Administration, Computer Science, Information Systems, or related field.

  • 5+ years of Business Analyst experience in the pharmacy, PBM, or healthcare industry.

  • Strong knowledge of PBM operations (claims processing, formulary, prior authorization, benefit design, eligibility, rebate management, specialty pharmacy, etc.).

  • Hands-on experience with EHR/EMR, pharmacy management systems, or PBM platforms.

  • Familiarity with HIPAA, CMS regulations, Medicare Part D, Medicaid, and healthcare compliance.

  • Excellent skills in requirements gathering, process modeling, data analysis, and documentation.

  • Proficiency with tools such as JIRA, Confluence, MS Visio, SQL, and Excel.

  • Strong communication, analytical thinking, and stakeholder management skills.

< data-start="2744" data-end="2779">Preferred Qualifications</>

  • Knowledge of FHIR, HL7, EDI transactions (NCPDP D.0, 270/271, 276/277, 278, 835/837, etc.).

  • Background in value-based care, healthcare analytics, or specialty pharmacy operations.

  • Certification such as CBAP, PMI-PBA, or Agile/Scrum is a plus.

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