Pharmacy Business Operations Analyst (Remote)

The Pharmacy Business Operations Analyst responsible for monitoring, analyzing, and improving pharmacy business operations processes with a focus on claim-level workflows, financial reconciliation, and operational effectiveness. The analyst supports day-to-day execution while also identifying trends, surfacing risks, and driving process improvements. The position will initially focus on workflows related to manufacturer pricing programs and Medicare initiatives (including Maximum Fair Price program operations), with flexibility to expand into broader pharmacy revenue integrity and reimbursement functions over time.

• Monitor and manage operational workflows including claim queues, aging, and status tracking to ensure timely processing and resolution
• Review and validate claim-level data for accuracy, completeness, and readiness for submission or follow-up
• Track and investigate discrepancies between internal findings and external determinations (e.g., manufacturer or platform outcomes)
• Partner cross-functionally with pharmacy operations, finance, 340B, revenue cycle, and analytics teams to resolve issues and improve workflows
• Maintain issue logs for disputed claims, payment delays, data mismatches, and manufacturer-specific recurring issues
• Perform financial reconciliation of expected versus actual payments, credits, and adjustments; escalate and resolve variances
• Develop and maintain reporting on key metrics such as volume, aging, turnaround times, financial impact, and dollars at risk
• Support development and maintenance of standard operating procedures, documentation, and control frameworks
• Support annual readiness planning as additional negotiated drugs enter the MFP program
• Analyze trends in claims, payments, and operational performance; provide actionable insights and recommendations
• Contribute to ongoing process optimization and scalability initiatives across pharmacy business operations
• Assist in readiness planning and implementation of new programs, policies, and regulatory requirements

• Performs other duties as assigned.
• Complies with all policies and standards.
• For specific duties and responsibilities, refer to documentation provided by the department during orientation.
• Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.

• Bachelor's Degree healthcare administration, business, pharmacy, or related field (Required) or
• equivalent experience may be considered (Preferred)

• 1+ years experience in pharmacy operations, reimbursement, 340B operations or payment reconciliation (Required) and
• Experience working with detailed data, including claim-level or transaction-level review (Required) and
• Strong analytical and problem-solving skills with attention to detail (Required) and
• Familiarity with 340B operations or manufacturer program processes (Preferred) or
• Experience with healthcare or pharmacy claims or payment workflows (Required) or
• Experience with business intelligence tools (e.g., Power BI, Tableau) (Preferred) or
• Exposure to SQL or other data querying tools (Preferred) or
• Experience with workflow or case management systems (e.g., Beacon or similar platforms) (Preferred) or
• Knowledge of pharmacy systems, reimbursement models, or regulatory programs (Preferred) or

• Ability to manage multiple priorities in a fast-paced, deadline-driven environment (Required proficiency)
• Proficiency in Excel (e.g., large datasets, pivot tables, data analysis) (Required proficiency)
• Demonstrated ownership mindset and ability to work independently (Required proficiency)
• Strong written and verbal communication skills (Preferred proficiency)
• Financial reconciliation and variance analysis (Preferred proficiency)
• Strong documentation discipline and ability to manage high-volume operational work with short turnaround expectations (Preferred proficiency)
• Operational analytics and process improvement (Preferred proficiency)
• Data validation and reporting (Preferred proficiency)
• Cross-functional collaboration and stakeholder management (Preferred proficiency)
• Problem-solving and critical thinking (Preferred proficiency)
• Process ownership and accountability (Preferred proficiency)
• Adaptability in a dynamic regulatory and operational environment (Preferred proficiency)

• Standing Occasionally
• Walking Occasionally
• Sitting Constantly
• Lifting Rarely up to 20 lbs
• Carrying Rarely up to 20 lbs
• Pushing Rarely up to 20 lbs
• Pulling Rarely up to 20 lbs
• Climbing Rarely up to 20 lbs
• Balancing Rarely
• Stooping Rarely
• Kneeling Rarely
• Crouching Rarely
• Crawling Rarely
• Reaching Rarely
• Handling Occasionally
• Grasping Occasionally
• Feeling Rarely
• Talking Constantly
• Hearing Constantly
• Repetitive Motions Frequently
• Eye/Hand/Foot Coordination Frequently

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