Gainwell is dedicated to empowering our clients through technology to deliver health and human services programs that enable successful health outcomes for beneficiaries nationwide.

As a Business Analyst - Pharmacy Benefit Management 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. You will c oordinate testing for the Pharmacy Benefit Management System (PBMS), Colorado interchange and relevant subsystems related to the PBMS implementation. Also, s erves as the liaison between the Department, Gainwell staff, and other contractor staff to translate new or revised processes, and coordinates with other sections in the Department to implement the Pharmacy Benefit Management System (PBMS). Here are the details on this position.

Your role in our mission

Gainwell empowers you show you’re a pro and help clients deliver better health and human services outcomes using innovative technology and solutions.

• Identifies, initiates and assures the quality of system functionality and change/enhancement projects in Interchange related to the Pharmacy Benefit Management System (PBMS) implementation, including as applicable all claims and capitation related system changes, pricing, benefit plans, reference codes, and interface file exchanges.
• Drafting configuration change management (CCM) documents and reviewing test cases on a large scale related to the PBMS implementation.
• Coordinates with pharmacy staff related to designing or enhancing systems, diagnosing system issues, analyzing test results, and coordinating system procedures in the Interchange related to the PMBS implementation
• Draft system requirements for new and revised processes to integrate the new PBMS and programs into the Interchange and collaborate with other system analysts and vendors in the development, validation process and review of technical specifications.
• Review test plans, technical specifications, test results and provide system documentation for new and revised processes.
• Assures Interchange changes align with the PBMS implementation and maintains a system of checks and balances to assure that data is consistent, complete and accurate
• Researches testing topics and validates that test results meet the identified functional requirements.
• Coordinates with program staff and system staff to review test results to ensure that the Interchange functions as intended.
• Analyze test results for defect findings and define the remediation process for the test environment while working within Gainwell to ensure that the defects are corrected, fully retested and approved for production
• Provide status report on testing to relevant staff and vendors.

What we're looking for

• Three or more years of Business Analyst Experience, with 1 or more years of Medicaid preferred.
• Prior Pharmacy Benefit Management System (PBMS) experience preferred.
• Advanced knowledge in Microsoft Excel and other software for conducting quantitative analysis. SQL experience is a plus
• Ability to create and document test scenarios according to the business requirements. Providing support with end user testing as needed.
• Strong analytical and business process re-engineering skill
• Strong written and oral communication and presentation skills to work with providers and managed care organizations related to claim submission in the Interchange and PBMS.

What you should expect in this role

• Fully remote options from most US locations and territories
• This position supports the state of Colorado, working hours will correspond to mountain time zone.
• Video cameras must be used during all interviews, as well as during the initial week of orientation