Pharmacy Operations Data Analyst (Hybrid—Portland)

Insperity; Portland, Northern (OR, KY); Hybrid; USD 60,000 - 75,000; Full time

Benefits offered by this job

Medical, Dental, Vision, Pharmacy, Lif

401K- Matching

FSA

Employee Assistance Program

PTO and Company Paid Holidays

Job summary

Moda Health in Portland, OR seeks a Pharmacy Operations Business Analyst to analyze pharmacy claims, validate benefit configurations, and support operational improvements across Commercial, Exchange, Medicare, and Medicaid lines. You will partner with Pharmacy Operations leadership, IT, Compliance, and vendor partners to monitor performance, test configurations, and ensure regulatory compliance.

This is a full-time, hybrid role with emphasis on CMS reporting, data validation, and developing

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, pharmacy benefit management, health plan administration, or a closely related healthcare environment.
• Knowledge of pharmacy benefit administration, claims processing, benefit configuration, formulary management, prior authorization operations, and workflows.
• Experience analyzing complex operational data, pharmacy claims, system functionality, and business processes to identify issues and improve operational performance.
• Experience developing business requirements, coordinating system testing, validating enhancements, and supporting implementations.
• Knowledge of Commercial, Exchange, Medicare, and Medicaid pharmacy operations and regulatory environments.
• Strong analytical, problem-solving, and root cause investigation skills with ability to interpret complex data.
• Ability to manage multiple priorities, work independently, and support concurrent initiatives.
• Strong written, verbal, presentation, and interpersonal communication skills with stakeholders.
• Proficiency with Microsoft Excel and experience with pharmacy systems or healthcare data platforms.
• Ability to develop documentation and testing documentation.

Responsibilities

• Analyze pharmacy claims, operational data, and system activity to identify trends, operational issues, and opportunities for improvement.
• Conduct root cause investigations for claims discrepancies, operational issues, configuration concerns, and vendor-related incidents.
• Develop operational reporting, dashboards, and monitoring tools to measure performance, identify emerging risks, and support operational decision-making.
• Perform data validation and operational monitoring to ensure the accuracy and integrity of pharmacy operations across Commercial, Exchange, Medicare, and Medicaid lines of business.
• Validate pharmacy benefit, formulary, network, and prior authorization configuration to ensure accurate claims adjudication and operational performance.
• Coordinate and perform testing supporting new client implementations, regulatory changes, and vendor releases.
• Develop business requirements, test plans, test scenarios, and validation documentation while tracking issues through resolution.
• Partner with internal stakeholders and vendor partners to evaluate system enhancements, validate implementation outcomes, and recommend operational improvements.
• Support Medicare Part D operational activities, including CMS reporting support, operational monitoring, audit readiness, and regulatory compliance initiatives.
• Identify opportunities to improve pharmacy operational processes through automation, standardization, enhanced reporting, and monitoring.
• Develop and maintain business requirements, operational procedures, process documentation, reporting specifications, and technical documentation supporting pharmacy operations.
• Provide analytical support for new client implementations, operational projects, system enhancements, and strategic initiatives.
• Collaborate with Pharmacy Operations, Clinical Pharmacy, Account Management, Information Technology, Compliance, Customer Service, and vendor partners to support operational excellence and continuous improvement.
• Analyze pharmacy operational data to identify trends, risks, and opportunities for improvement.
• Perform claims analysis, configuration validation, and root cause investigations to support operational excellence.
• Develop reporting and monitoring solutions that improve operational visibility and oversight.
• Support operational implementations through requirements gathering, testing, validation, and post-implementation analysis.
• Ensure the accuracy and integrity of pharmacy operational systems through ongoing monitoring, testing, and data validation.
• Collaborate with internal teams and vendor partners to improve operational performance and resolve complex business issues.
• Support regulatory compliance, audit readiness, and continuous process improvement initiatives.

Skills

Analytical skills

Problem-solving

Communication skills

Manage multiple priorities

Presentation skills

Team collaboration

Education

Bachelor's degree in healthcare administration or related field

Tools

Excel

Power BI

SQL

Tableau

Pharmacy systems

Job description

Moda Health in Portland, OR seeks a Pharmacy Operations Business Analyst to analyze pharmacy claims, validate benefit configurations, and support operational improvements across Commercial, Exchange, Medicare, and Medicaid lines. You will partner with Pharmacy Operations leadership, IT, Compliance, and vendor partners to monitor performance, test configurations, and ensure regulatory compliance.

This is a full-time, hybrid role with emphasis on CMS reporting, data validation, and developing