AmeriHealth Caritas · 4 hours ago
Pharmacy Business Systems Analyst
United States
Full-time
Remote
Mid, Senior Level
5+ years expAmeriHealth Caritas is a mission-driven organization dedicated to providing comprehensive healthcare solutions. The Business Systems Analyst II will analyze business requirements related to Pharmacy technical deliverables and ensure their successful implementation and support.
Health CareInformation Technology
Responsibilities
Engage as the technical point-of-contact on pharmacy data and EDI (Electronic Data Interchange) deliverables, particularly Eligibility, Prescription Drug Event (PDE), Encounter, Claims, User Access, File Transfers, and connectivity, during new implementations and operational support
Work closely with business stakeholders to build and analyze business and functional requirements as relates to application and data systems
Define scope of the project and develop implementation strategies and project plans for development, testing, and implementation while tracking dependencies
Define test conditions and develop accurate and complete testing scenarios prior to implementation of new or updated technical deliverables
Coordinate activities with all departments and technical personnel as required for the rollout of new implementations
Maintain expert knowledge of business processes specific to direction, structure, and requirements, and identify deficiencies and recommend system improvements
Assess operational impacts related to project in regards to data integrity, data workflow, and address accordingly as required for successful implementation
Troubleshoot implementation and operational issues related to EDI deliverables (eligibility, claims, PDE, Encounters, User access) and work with vendor and/or Developers for resolution
Qualification
Required
Bachelor's Degree or an equivalent combination of education and work experience required
Minimum three (3) years of progressively more responsible related work experience, necessary in order to gain understanding of application data systems, operations, quality assurance processes, and business analysis skills
Minimum five (5) years of experience with industry (Pharmacy preferred) payer file exchange inclusive of Medicare, Medicaid, Commercial and compliance requirements
Project coordination experience
Problem-solving skills and the ability to understand how various issues affect each other and the outcome of projects
Must possess analytical ability required to perform data analysis, reconcile defects, and recommend solutions
Minimum one (1) year of technical experience in the creation and use of SQL queries
Preferred
Payer Claims lifecycle knowledge and/or experience is a plus
Benefits
Flexible work solutions include remote options
Hybrid work schedules
Competitive pay
Paid Time Off (PTO), including holidays and volunteer events
Health insurance coverage for you and your dependents on Day 1
401(k)
Tuition reimbursement
And more.
Company
AmeriHealth Caritas
AmeriHealth Caritas is the health care solutions provider for those in most need and the chronically ill.
10001+ employees
H1B Sponsorship
AmeriHealth Caritas has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (18)
2024 (17)
2023 (12)
2022 (14)
2021 (4)
2020 (11)
Funding
Current Stage
Late StageLeadership Team
Kathleen Giblin
SVP Clinical Operations
Ash Hanson
Executive Vice President & Chief Human Resources Officer
Recent News
2025-11-06
The Philadelphia Inquirer
2025-10-02
2025-10-01
Company data provided by crunchbase