Business Analyst, Ffs Medicaid Claims- Remote

Putting People First in Pharmacy- Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other.

The Business Analyst (BA), Fee for Service (FFS) Medicaid Claims Processing will provide Business Analysis support for the development, implementation, and maintenance of our Navitus NCRx platform when applied to FFS regulatory accounts. The FFS implementations require full compliance to NCPDP standards as they emerge including the current D.0 standard for pharmacy claims and the subsequent NCPDP F6 standard. Further, the Business Analyst will be responsible for informing the FFS leadership of the functional evolution of the market needs in support of improving product releases.

The BA reports to the Portfolio Manager. The BA is part of related agile teams that are developing the next generation in pharmacy claims processing. The analyst is expected to provide creativity in addressing the unique needs of the product’s constituents and applying state-of-the-art information system concepts and solutions. The BA is expected to work with Navitus internal and external resources to determine projected business needs and translate those needs into the module architecture. The BA will also support procurement activities, ensuring claims responses align with capabilities. Developing solutions further require the BA to approve detailed requirements, work breakdown structures, and other deliverables that support the development and implementation of a best in class tool.

The BA will apply demonstrable communication, analytical, and problem-solving skills to help support development and product lifecycle activities.

Is this you? Find out more below!

How do I make an impact on my team?

• Develop and maintain deep knowledge of NCPDP pharmacy POS claims processing requirements.
• Develop an understanding of unique attributes within a claim transaction where contracted State governments apply specific regulatory requirements to support their programs.
• Understand the competitive landscape, regulatory lifecycle and related government processes surrounding FFS.
• Facilitate and moderate gap analysis and requirements gathering sessions for as-is and to-be stages of product development and accountable for compliance with state compliance.
• Learn and apply technical tools that support the product development process and used to communicate the business features to the technical design and development teams.
• With input from key stakeholders, prioritize business needs of the product and incorporate the criteria to develop the product’s functional releases.
• Facilitate productive discussions to gather and document in both text and visual formats the expected functionality for this product and how it supports the FFS portfolio.
• Moderate the development teams to ensure functional and non-functional requirements are understood and implemented consistent with the BA vision.
• Work with the team to identify, analyze, quantify, and mitigate risks.
• Work with the project management office to utilize and enhance tools that support the requirements, development, and testing processes.

What our team expects from you?

• 4 years of Business Analyst experience required and Bachelor’s degree preferred; relevant certifications from recognized industry organizations
• Experience documenting complex technical processing functions is required
• Experience with implementation of government regulations into software development activities is required
• Experience participating in an agile development project team is required
• Experience with core software applications, including Microsoft Word and Excel is required
• Knowledge of Software Development Lifecycle (SDLC) methodologies is required
• Experience in roles like a Business Analyst, Business Systems Analyst, or Product Manager is required
• Participate in, adhere to, and support compliance program objectives
• The ability to consistently interact cooperatively and respectfully with other employees

What can you expect from Navitus?

• Hours/Location: Monday – Friday: 8:00am-5:00pm CST, Appleton Office or remote.
• Paid Volunteer Hours
• Educational Assistance Plan and Professional Membership assistance
• Referral Bonus Program – up to $750!
• Top of the industry benefits for Health, Dental, and Vision insurance, Flexible Spending Account, Paid Time Off, Eight paid holidays, 401K, Short-term and Long-term disability, College Savings Plan, Paid Parental Leave, Adoption Assistance Program, and Employee Assistance Program