Business Analyst NCPDP

About Gainwell Technologies

Gainwell Technologies is a leading provider of innovative healthcare technology solutions dedicated to improving health and human services outcomes for vulnerable communities. The company leverages cutting-edge technologies and industry expertise to deliver impactful solutions that address complex healthcare challenges. Gainwell supports a flexible work environment, fostering continuous learning and career development through technical certifications, leadership academies, and educational assistance. With a strong commitment to diversity, equity, and inclusion, Gainwell strives to create an inclusive workplace where collaboration and innovation thrive. The organization’s mission is to make healthcare work better for everyone by empowering its employees and clients with the tools and knowledge needed to achieve meaningful results.

About the Business Analyst NCPDP Role

The Business Analyst NCPDP at Gainwell plays a crucial role in supporting healthcare clients by translating technical goals into actionable business solutions. This position involves analyzing, designing, documenting, and recommending improvements to business processes aligned with client technological objectives. The Business Analyst serves as a vital communication link between clients, project managers, and technical teams, ensuring clear understanding and documentation of business requirements. The role also includes creating and executing test scenarios to verify system functionalities, participating in technical reviews, and ensuring that project deliverables meet client expectations. Candidates will work remotely within the continental US, contributing to projects that enhance healthcare services through innovative technology solutions. The position offers an excellent opportunity to grow professionally within a dynamic organization committed to making a positive impact on healthcare delivery.

Key Responsibilities

• Analyze, plan, design, and document business processes to support client technological goals.
• Act as a liaison between clients, project managers, and technical teams to define and communicate business requirements.
• Create and execute test scenarios to verify system functionalities align with client requirements.
• Participate in technical reviews, inspections, and project phases to ensure successful implementation of changes.
• Conduct regular audits of business processes, policies, and operational workflows to ensure compliance with standards and regulations.
• Review and validate policy implementation across departments, identifying risks and areas for improvement.
• Develop audit plans, checklists, and methodologies to ensure consistent audit practices.
• Document audit findings and prepare actionable reports for leadership and stakeholders.
• Design, document, and implement configurable policy-based system updates within Claims, Reference Data Maintenance, and Business Policy Administration modules.
• Manage updates for claim forms, member benefit plans, and coverage/reimbursement rules based on client needs.
• Implement quarterly code set updates, including adding coverage rules and updating state-specific restrictions.

Qualifications

• Minimum of three years of Business Analysis experience within the Healthcare industry.
• Understanding of NCPDP standards and protocols.
• Experience with Electronic Data Interchange (EDI) processing, pharmacy claims, and Medicaid Management Information Systems (MMIS).
• Knowledge of system design, configuration, solutioning, and testing phases.
• Proficiency in facilitating client meetings to gather and document requirements.
• Ability to create, document, and present system test plans and scenarios.
• Basic understanding of computer programming concepts such as configuration, development, and batch processing.
• Advanced skills in Microsoft Excel and other analytical software tools.
• Strong analytical skills and experience in business process re-engineering.
• Excellent written and oral communication skills, with the ability to present to business leaders and technical teams.
• Ability to work collaboratively, influence others, and motivate teams.
• Experience with audit and compliance processes, including policy documentation and operational workflows.
• Knowledge of claim forms (Physician, Institutional, Dental, Pharmacy) and member benefit plan configuration.
• Experience in system solutioning, creating new functionalities, and implementing policy-based system updates.
• Familiarity with quarterly code set updates and state-specific service restrictions.

Benefits

• Generous, flexible vacation policy.
• Comprehensive health benefits.
• 401(k) employer matching program.
• Educational assistance and professional development opportunities.
• Leadership and technical development academies.
• Work flexibility, including fully remote options from the continental US.

Key skills/competency

• Business Analysis
• NCPDP Standards
• Electronic Data Interchange (EDI)
• Pharmacy Claims
• Medicaid Management Information Systems (MMIS)
• System Design
• Requirements Gathering
• Test Scenarios
• Audit & Compliance
• Policy Management