Healthcare Data Analyst PBM Data Modernization at Remote

Hi,

Hope you are doing well

Please find the Job Description (JD) below.

Role : Healthcare Data Analyst PBM Data Modernization

Location: Remote

Industry: Pharmacy Benefit Management (PBM)

Reports to: Data Architect

Role Overview

We are looking for a Healthcare Data Analyst to support the Data Architect on a PBM data modernization program. This is a functional role. You'll research legacy systems and reports, document how pharmacy data is used today, and turn state Medicaid reporting requirements into clear mapping and business rules for the new data warehouse.

Key Responsibilities

• Research legacy systems, data sources, and IBM Cognos reports to document data definitions, business rules, and how each field is used.

• Complete source-to-target mapping documents to the standards set by the Data Architect, capturing field definitions, business rules, and open questions.

• Gather and document state-specific Medicaid reporting requirements, such as encounter submissions, PBM transparency reports, and pricing disclosures, and trace each requirement to its source data.

• Run working sessions with business users, pharmacy operations, and compliance teams to confirm definitions and resolve data questions.

• Identify and log data gaps, then track them to resolution with the Data Architect.

• Support testing by validating report outputs and reconciling results between legacy and new systems.

Qualifications

• 5+ years as a data, business, or systems analyst in healthcare, with at least 2 years in PBM, pharmacy claims, or Medicaid managed care.

• Solid working knowledge of pharmacy claims, member eligibility, formulary, pricing, and rebate concepts, and familiarity with NCPDP standards.

• Understanding of state Medicaid reporting and CMS requirements; experience with encounter data or T-MSIS is a strong plus.

• Experience writing source-to-target mappings, data dictionaries, and requirements documents.

• Working SQL skills for data research and validation; exposure to Cognos, BigQuery, or Looker is a plus.

• Clear communicator who can work with both business and technical teams, and is comfortable using AI tools to speed up research and documentation.