This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more.

Role Description

As a Business Analyst - NCPDP at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges.

• Analyze, plan, design, document and make recommendations to improve business processes to support client’s technological aspirations
• Be a supportive bridge between clients, project managers and technical personnel to define, track and communicate business requirements and their expected impact by building basic conceptual data and process models
• Create, execute or analyze basic test scenarios to verify that client requirements are built into system design
• Ensure that “intent of change” is carried out through every project phase by participating in technical reviews and inspections

Qualifications

• Three or more years of Business Analysis experience in Healthcare industry translating technical goals and requirements into real action for clients
• Understanding of NCPDP standards
• Experience with EDI processing, pharmacy claims and Medicaid Management Information Systems (MMIS)
• Familiar with system design, solutioning, configuration, and testing phases
• Facilitates meetings with clients to gather and document requirements and secure design sign-off as needed
• Creating, documenting, and presenting system test plans/scenarios to the client
• Knowledge of basic computer programming concepts such as configuration, development and batch processing
• Advanced knowledge of Microsoft Excel and other software for conducting quantitative analysis
• Strong analytical and business process re-engineering skills
• Strong written and oral communication and presentation skills to deliver messages to business leaders, clients and technical personnel
• An influencer and team player who motivates others to action and communicates key technical ideas in a digestible way

Requirements

• Conduct regular audits of business processes, policy documentation, and operational workflows to ensure compliance with internal standards and regulatory requirements
• Review and validate policy implementation across departments, identifying inconsistencies, risks, and areas for improvement
• Develop audit plans, checklists, and methodologies to support consistent and repeatable audit practices
• Document audit findings and prepare clear, actionable reports for leadership and stakeholders
• Familiar with audit frameworks, risk management principles, or quality assurance methodologies
• Analyze, estimate, design, document, and implement configurable policy-based system updates in the Claims, Reference Data Maintenance, and Business Policy Administration (BPA) functional areas
• Experience with all four claim forms: Physician, Institutional, Dental, and Pharmacy
• Experience with member benefit plan configuration updates
• Experience solutioning and creating new system functionality to audit / deny claims based on client’s needs
• Implement quarterly code set updates, adding coverage/reimbursement rules and updating state specific service restrictions for all procedure, revenue, NDC/GSN/STC code types

Benefits

• Generous, flexible vacation policy
• 401(k) employer match
• Comprehensive health benefits
• Educational assistance
• Leadership and technical development academies to help build your skills and capabilities

Company Description

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.