Remote PBM Solutions Architect: Data Exchanges & Onboarding

Personify Health, Inc.; United States; Remote; USD 120,000 - 160,000; Full time

Benefits offered by this job

Medical and dental coverage

Unlimited PTO

Mental health support

Professional development

Retirement planning

Job summary

Personify Health is seeking an experienced healthcare architect to design operational workflows for eligibility, claims, billing, and benefit administration. You will act as the go-to architect for PBM solutions, data exchanges, and vendor onboarding.

You will negotiate rebates and pricing agreements while tracking drug costs and PMPM performance, and collaborate across teams to optimize health plan administration and care navigation.

Qualifications

• 7+ years in healthcare, TPA operations, product, or systems architecture.
• Deep knowledge of PBM operations, data formats, and compliance requirements (HIPAA, CMS).
• Strong skills in process documentation, analytics, and cross-functional collaboration.

Responsibilities

• Design operational workflows for eligibility, claims, billing, and benefit administration.
• Serve as the go-to architect for PBM solutions, data exchanges, and vendor onboarding.
• Negotiate rebate and pricing agreements while tracking drug cost and PMPM performance.

Skills

PBM operations

HIPAA CMS compliance

Process documentation

Analytics

Cross-functional collaboration

Education

7+ years healthcare/TPA operations experience

Job description

Personify Health is seeking an experienced healthcare architect to design operational workflows for eligibility, claims, billing, and benefit administration. You will act as the go-to architect for PBM solutions, data exchanges, and vendor onboarding.

You will negotiate rebates and pricing agreements while tracking drug costs and PMPM performance, and collaborate across teams to optimize health plan administration and care navigation.