Pharmacy Operations Data Analyst

Page Mechanical Group, Inc.; Portland (OR); Hybrid; USD 60,000 - 75,000; Full time

Benefits offered by this job

Medical benefits

401K Matching

Flexible Spending Account

Employee assistance program

Paid time off

Job summary

Moda Health, based in Oregon, is seeking a Pharmacy Operations Business Analyst to support the design, validation, monitoring, and continuous improvement of pharmacy operations, configurations, and vendor performance. This role ensures accuracy of PBM operations across Commercial, Exchange, Medicare, and Medicaid lines of business.

The candidate will analyze claims, configure formulary settings, implement new client requirements, and develop reporting tools to improve efficiency, regulatory

Qualifications

• Bachelor's degree or equivalent combination of education and relevant experience in healthcare administration, business administration, pharmacy, information systems, or a related field.
• Five or more years of professional experience in pharmacy operations, PBM, or health plan administration.
• Knowledge of pharmacy benefit administration, claims processing, formulary management, and prior authorization operations.
• Experience analyzing complex operational data and claims to identify issues and drive performance.
• Experience developing business requirements, testing, validation, and supporting implementations.

Responsibilities

• Analyze pharmacy claims, operational data, and system activity to identify trends, risks, and opportunities for improvement.
• Conduct root cause investigations for claims discrepancies and vendor incidents.
• Develop reporting, dashboards, and monitoring tools to measure performance and support decisions.
• Perform data validation and monitoring across Commercial, Exchange, Medicare, and Medicaid lines of business.

Skills

Pharmacy operations

Pharmacy benefit management

CMS compliance

Data analysis

Stakeholder communication

Education

Bachelor's degree in healthcare administration or related field

Tools

Excel

Power BI

Pharmacy systems

Job description

Moda Health, based in Oregon, is seeking a Pharmacy Operations Business Analyst to support the design, validation, monitoring, and continuous improvement of pharmacy operations, configurations, and vendor performance. This role ensures accuracy of PBM operations across Commercial, Exchange, Medicare, and Medicaid lines of business.

The candidate will analyze claims, configure formulary settings, implement new client requirements, and develop reporting tools to improve efficiency, regulatory