AndHealth · 3 weeks ago
Pharmacy Program Optimization Analyst
Columbus, OH
Full-time
Onsite
Entry, Mid LevelAndHealth is on a mission to radically improve access and outcomes for the most challenging chronic health conditions. They are seeking a Pharmacy Program Optimization Analyst to maximize the efficiency and effectiveness of federal drug pricing programs by analyzing pharmacy claims data and identifying optimization opportunities.
Health CareMedical
Responsibilities
Analyze pharmacy claims data across multiple partners to identify trends, anomalies, and missed revenue opportunities
Investigate unpaid or uncaptured claims through structured root cause analysis, working with FQHC partners, TPAs, and pharmacy operations teams to implement durable fixes that improve paid claim rates and data integrity
Evaluate billing configurations, payer carve-out logic, and submission pathways to ensure claims are routed correctly and in compliance with program requirements
Query and analyze data from EHRs, TPAs, and pharmacy operating systems to validate eligibility, utilization, and claim capture, identifying optimization opportunities across workflows
Troubleshoot live data, system, and integration issues that impact program eligibility, utilization, or optimization
Build and maintain reporting to track monthly savings, utilization, and performance trends, supporting financial optimization, forecasting, and leadership visibility
Produce audit-ready datasets and reports to support compliance reviews and external audits
Stay current on manufacturer policies, reimbursement rules, and HRSA (Health Resources and Services Administration) OPAIS updates - assessing their impact on program optimization and advising stakeholders on required changes
Partner cross-functionally to improve program workflows, documentation, and operational efficiency, contributing to continuous improvement initiatives
Support program growth and evolving analytical needs as assigned
Qualification
Required
Bachelor's degree in Analytics, Computer Science, Economics, Engineering, Mathematics, or a related quantitative field — or equivalent practical experience
Strong proficiency in SQL, including writing complex queries, joins, aggregations, and performance optimization
Hands-on experience with ETL processes, including data extraction, transformation, validation, and loading across multiple systems
Strong analytical and problem-solving skills, including the ability to perform root cause analysis and identify process improvements
Advanced proficiency in Microsoft Excel (e.g., pivot tables, lookups, complex formulas)
Comfort working across multiple systems and reconciling data inconsistencies
Strong attention to detail, including numerical accuracy and data validation
Ability to manage competing priorities and operate effectively in a fast-paced environment
Ability to work independently, take initiative, and continuously improve processes
Clear written and verbal communication skills, with the ability to explain complex findings to non-technical audiences
Preferred
340B ACE Certification preferred but not required
Experience working with healthcare data, claims, or other regulated environments
Familiarity with pharmacy operations, reimbursement workflows, or revenue optimization
Exposure to EHRs or other operational healthcare systems
Knowledge of the 340B Drug Pricing Program or willingness to pursue certification
Benefits
Medical
Dental
Vision Insurance
Paid time off
Short- and Long-Term Disability
Company
AndHealth
AndHealth helps people reverse chronic diseases.
Founded in 2021
201-500 employees
Funding
Current Stage
Growth StageTotal Funding
$72MKey Investors
Francisco Partners
2025-08-20Series Unknown· $15M
2022-02-10Seed· $57M
Leadership Team
Matt Scantland
Founder and CEO
Recent News
2025-10-10
2025-06-06
Company data provided by crunchbase