Business Analyst - NCPDP

Gainwell offers a chance to work with leading-edge technologies to improve the health and well-being of vulnerable communities. The company supports work flexibility, learning, and career development, with opportunities to grow technical credentials and certifications, a generous vacation policy, educational assistance, and leadership and technical development academies.

As a Business Analyst - NCPDP at Gainwell, you will contribute to helping clients improve health and human services outcomes through technology. This role supports teams in delivering innovative solutions to healthcare challenges. Here are the details on this position.

Gainwell empowers you to demonstrate professionalism and help clients achieve better health outcomes through innovative technology and solutions.

• Analyze, plan, design, document, and make recommendations to improve business processes to support the client’s technological goals
• Act as a bridge between clients, project managers, and technical personnel to define, track, and communicate business requirements and their expected impact by building basic conceptual data and process models
• Create, execute, or analyze basic test scenarios to verify that client requirements are reflected in system design
• Ensure that the intended change is carried out through every project phase by participating in technical reviews and inspections

• Three or more years of Business Analysis experience in the Healthcare industry translating technical goals and requirements into action for clients
• Understanding of NCPDP standards
• Experience with EDI processing, pharmacy claims, and Medicaid Management Information Systems (MMIS)
• Familiar with system design, solutioning, configuration, and testing phases
• Facilitates meetings with clients to gather and document requirements and secure design sign-off as needed
• Creates, documents, and presents system test plans/scenarios to the client
• Knowledge of basic computer programming concepts such as configuration, development, and batch processing
• Advanced knowledge of Microsoft Excel and other software for conducting quantitative analysis
• Strong analytical and business process re-engineering skills
• Strong written and oral communication and presentation skills to deliver messages to business leaders, clients, and technical personnel
• Ability to influence and work as part of a team, motivating others to action and communicating technical ideas clearly

• Conduct regular audits of business processes, policy documentation, and operational workflows to ensure compliance with internal standards and regulatory requirements
• Review and validate policy implementation across departments, identifying inconsistencies, risks, and areas for improvement
• Develop audit plans, checklists, and methodologies to support consistent and repeatable audit practices
• Document audit findings and prepare clear, actionable reports for leadership and stakeholders
• Familiar with audit frameworks, risk management principles, or quality assurance methodologies
• Analyze, estimate, design, document, and implement configurable policy-based system updates in the Claims, Reference Data Maintenance, and Business Policy Administration (BPA) functional areas
• Experience with all four claim forms:
  Physician, Institutional, Dental, and Pharmacy
• Experience with member benefit plan configuration updates
• Experience solutioning and creating new system functionality to audit/deny claims based on client needs
• Implement quarterly code set updates, adding coverage/reimbursement rules and updating state-specific service restrictions for all code types (procedure, revenue, NDC/GSN/STC)

• Fully remote options from continental US locations only
• Video cameras must be used during all interviews and during the initial week of orientation
• The deadline to submit applications for this posting is March 3, 2026

Compliance:
The pay range for this position is $49,400.00 - $70,600.00 per year, which may vary based on geographic region, internal equity, job-related knowledge, skills, and experience. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. Gainwell offers leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell on our company website and visit our Careers site for all available job openings.

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy,…