The Pharmacy Business Operations Analyst responsible for monitoring, analyzing, and improving pharmacy business operations processes with a focus on claim-level workflows, financial reconciliation, and operational effectiveness. The analyst supports day-to-day execution while also identifying trends, surfacing risks, and driving process improvements. The position will initially focus on workflows related to manufacturer pricing programs and Medicare initiatives (including Maximum Fair Price program operations), with flexibility to expand into broader pharmacy revenue integrity and reimbursement functions over time.
What You Will Do
Monitor and manage operational workflows including claim queues, aging, and status tracking to ensure timely processing and resolution
Review and validate claim-level data for accuracy, completeness, and readiness for submission or follow-up
Track and investigate discrepancies between internal findings and external determinations (e.g., manufacturer or platform outcomes)
Partner cross-functionally with pharmacy operations, finance, 340B, revenue cycle, and analytics teams to resolve issues and improve workflows
Maintain issue logs for disputed claims, payment delays, data mismatches, and manufacturer-specific recurring issues
Perform financial reconciliation of expected versus actual payments, credits, and adjustments; escalate and resolve variances
Develop and maintain reporting on key metrics such as volume, aging, turnaround times, financial impact, and dollars at risk
Support development and maintenance of standard operating procedures, documentation, and control frameworks
Support annual readiness planning as additional negotiated drugs enter the MFP program
Analyze trends in claims, payments, and operational performance; provide actionable insights and recommendations
Contribute to ongoing process optimization and scalability initiatives across pharmacy business operations
Assist in readiness planning and implementation of new programs, policies, and regulatory requirements
Additional Responsibilities
Performs other duties as assigned.
Complies with all policies and standards.
For specific duties and responsibilities, refer to documentation provided by the department during orientation.
Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.
Equal Opportunity Employer – minorities/females/veterans/individuals with disabilities/sexual orientation/gender identity
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