Pharmacy Operations Business Analyst Job Northern Kentucky USA,Healthcare

About Moda

Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together.

Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Let’s be better together.

Position Summary

This is a FT hybrid position based in Portland. The Pharmacy Operations Business Analyst serves as the technical and analytical resource for Pharmacy Operations, supporting the design, validation, monitoring, and continuous improvement of pharmacy operational processes, systems, and vendor performance. The role is responsible for analyzing pharmacy claims, validating benefit and formulary configuration, supporting operational implementations, developing reporting and monitoring tools, and identifying opportunities to improve operational efficiency, accuracy, and regulatory compliance.

Working closely with Pharmacy Operations leadership, Information Technology, Account Management, Compliance, vendor partners, and other business stakeholders, the Pharmacy Operations Business Analyst performs complex operational analysis, root cause investigations, data validation, configuration testing, and system support across Commercial, Exchange, Medicare, and Medicaid lines of business. The role plays a critical part in ensuring the accuracy of pharmacy benefit administration, supporting CMS reporting and audit activities, monitoring operational performance, and implementing sustainable controls that improve quality and reduce operational risk.

Pay

Range

$59,922.05 - $74,902.56 annually (depending on experience).

* Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.

Benefits

Medical, Dental, Vision, Pharmacy, Life, & Disability
401K
- Matching
FSA
Employee Assistance Program
PTO and Company Paid Holidays

Required Skills, Experience &

Education:

Bachelor's degree or equivalent combination of education and relevant experience in healthcare administration, business administration, pharmacy, information systems, or a related field.

Five or more years of professional experience in pharmacy operations, pharmacy benefit management, health plan administration, or a closely related healthcare environment.

Demonstrated knowledge of pharmacy benefit administration, pharmacy claims processing, benefit configuration, formulary management, prior authorization operations, and operational workflows.

Experience analyzing complex operational data, pharmacy claims, system functionality, and business processes to identify issues, recommend solutions, and improve operational performance.

Experience developing business requirements, coordinating system testing, validating system enhancements, and supporting operational implementations.

Demonstrated knowledge of Commercial, Exchange, Medicare, and Medicaid pharmacy operations and applicable regulatory environments.

Strong analytical, problem-solving, and root cause investigation skills with the ability to interpret complex operational and claims data

Demonstrated ability to manage multiple priorities, work independently, and successfully support concurrent operational initiatives.

Strong written, verbal, presentation, and interpersonal…