Gainwell Technologies

Business Analyst - Pharmacy

Gainwell Technologies  •  $52k - $74k/yr  •  Arkansas (Remote)  •  1 month ago
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Job Description

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.

As a Business Analyst - Pharmacy at Gainwell, you we deliver high-impact Medicaid and public health technology solutions to improve health outcomes and operational efficiency. As a leader in healthcare IT, we support pharmacy benefit programs, MMIS modernization, data-driven decision-making, and mission-critical state health systems.

The Professional 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.

Here are the details on this position.

Your role in our mission

Business Analysis & Requirements

  • 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.

Pharmacy IT & System Support

  • 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.

Testing & Quality Assurance

  • 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.

... your role continued

Project & Stakeholder Management

  • 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.

Operational & Compliance Support

  • 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.

What we're looking for

  • 3+ years of experience in business analysis within healthcare or pharmacy IT environments.
  • Bachelor’s degree in Business, Healthcare, Information Systems, Pharmacy, or related field.
  • 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. (strongly preferred)
  • 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).

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.

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 has been extended until a suitable candidate is selected.
  • #LI-HC1
  • #LI-Pharmacy

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.

Gainwell Technologies

About Gainwell Technologies

For 50 years, our nation’s federal Medicaid program has worked to improve the health, safety and well-being of America’s most vulnerable populations: low-income families, women and children, seniors, and those with disabilities. With positive health and cost outcomes that pierce inequities and impact economies, the success of these programs is inextricably tied to the prosperity of communities, individual states and the nation as a whole. We think that demands respect and, more importantly, is deserving of a lifetime commitment from innovators who can help those who operate within and around health and human services evolve — in any market at any stage. At Gainwell Technologies, that’s our sole focus.

Built across more than five decades, Gainwell has intentionally seized opportunities to advance its digitally enabled services to meet agencies, health plans and MCOs where they are on their modernization journeys and propel them into the future of public health. Our commitment to innovation, deep experience and ability to leverage insights from customers across 50 states has allowed us to expand on next-generation, cloud-enabled technologies.

Today, Gainwell offers one of the most comprehensive suites of scalable services and solutions on the market — all proven to deliver cost savings, better patient outcomes and an improved provider experience. Equally important to our expanding technologies and results: We bring ideas that bring policies to life.

Industry
IT & Software
Company Size
10,000+ employees
Headquarters
United States
Year Founded
Unknown
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