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We are seeking an experienced Business Analyst with healthcare technology experience to support pharmacy and claims processing initiatives. This role serves as the critical link between business stakeholders and technical teams, ensuring requirements are accurately gathered, documented, and translated into effective system solutions.
Job Responsibility
Gather, analyze, and document business, functional, and system requirements
Translate business needs into detailed functional specifications, workflows, process maps, and user stories
Collaborate with business stakeholders, technical teams, and external partners to ensure alignment throughout project lifecycles
Facilitate requirements sessions, stakeholder interviews, and solution discussions
Analyze pharmacy claims processing workflows and adjudication processes
Support initiatives involving NCPDP transaction standards and related healthcare data exchanges
Evaluate eligibility, prior authorization, drug data, and claims processing requirements
Assist with issue analysis, troubleshooting, and resolution efforts related to pharmacy systems
Identify operational inefficiencies and recommend process improvements
Work closely with development and QA teams to support system enhancements and integrations
Create and maintain process documentation, workflows, business rules, and system documentation
Support solution design discussions and impact assessments
Assist with test planning, test case development, and User Acceptance Testing (UAT)
Validate system functionality against documented requirements
Support defect tracking, resolution, and post-implementation validation activities
Facilitate project meetings and requirements reviews
Support SDLC activities from requirements gathering through implementation
Coordinate with cross-functional teams to ensure project deliverables are completed on schedule
Requirements
Bachelor's degree in Information Technology, Business, Healthcare Administration, or a related field
3 to 8+ years of Business Analyst experience
Experience supporting healthcare, pharmacy, PBM, or claims processing systems
Strong requirements gathering, documentation, and stakeholder management skills
Experience working within structured project and SDLC environments
Knowledge of NCPDP standards and pharmacy claims processing
Experience with SQL for data analysis and validation
Advanced Microsoft Excel skills
Experience with process modeling, workflow documentation, and business analysis tools
Nice to have
Medicaid pharmacy program experience
Familiarity with MMIS transactions and healthcare data exchanges
Experience supporting PBM platforms or pharmacy benefit programs
Professional certifications such as CBAP, CCBA, or similar Business Analysis credentials