Pharmacy Ops Analytics & Process Improvement Lead

Moda Health; Portland (OR); Hybrid; USD 60,000 - 75,000; Full time

Benefits offered by this job

Medical, Dental, Vision

401K Matching

FSA

Employee Assistance Program

PTO and Holidays

Job summary

Moda Health in Portland, OR is seeking a Pharmacy Operations Business Analyst to serve as the technical and analytical resource for Pharmacy Operations. You will analyze pharmacy claims, validate benefit configuration, support implementations, and develop reporting tools to improve efficiency and regulatory compliance.

You will work with Pharmacy Operations leadership, IT, account management, Compliance, and vendor partners across Commercial, Exchange, Medicare, and Medicaid lines to ensure

Qualifications

• Bachelor's degree or equivalent in health admin, business, pharmacy, information systems, or related field.
• Five+ years in pharmacy operations, PBM, health plan administration, or related healthcare.
• Knowledge of pharmacy benefit administration, claims processing, formulary management, prior authorization, and workflows.
• Experience analyzing complex data to identify issues and improve performance.
• Experience developing business requirements, testing, and system implementations.
• Knowledge of Commercial, Exchange, Medicare, and Medicaid pharmacy operations and regulatory environments.
• Strong analytical and root-cause investigation skills.
• Ability to manage multiple priorities and work independently.
• Strong written and verbal communication with stakeholders.
• Proficiency with Excel and pharmacy ops systems/reporting tools.
• Ability to develop documentation and testing docs.

Responsibilities

• Analyze pharmacy operational data to identify trends, risks, and opportunities for improvement.
• Perform root cause investigations for claims discrepancies and vendor incidents.
• Develop dashboards and monitoring tools to measure performance.
• Support regulatory compliance, CMS reporting, and audit readiness.
• Collaborate with internal teams and vendors to improve operations.
• Support client implementations and system enhancements.

Skills

Analytical thinking

Root cause analysis

Communication skills

Cross-functional collaboration

Problem-solving

Detail-oriented

Education

Bachelor's degree in healthcare administration, business administration, pharmacy, information systems, or a related field

Tools

SQL

Power BI

Tableau

Excel

Pharmacy systems

Job description

Moda Health in Portland, OR is seeking a Pharmacy Operations Business Analyst to serve as the technical and analytical resource for Pharmacy Operations. You will analyze pharmacy claims, validate benefit configuration, support implementations, and develop reporting tools to improve efficiency and regulatory compliance.

You will work with Pharmacy Operations leadership, IT, account management, Compliance, and vendor partners across Commercial, Exchange, Medicare, and Medicaid lines to ensure