Business Analyst - Pharmacy

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.

Summary

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 Dev Ops (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…