General Description
We seek a Business System Processing – Data Analyst to design, build, and maintain robust data pipelines supporting our pharmacy claims TPA operations in the 340B space. This role focuses on AWS Glue, S3, RDS SQL Server, and Python-driven ETL processes, with responsibility for production support of our CPE claims processing platform. The candidate will collaborate with cross-functional teams to ensure seamless data ingestion, claims processing, and client implementations while driving process improvements in file and data management.
This role involves ensuring seamless core processing across various domains, including EHR data ingestion and normalization, prescription claims management, drug pricing, and reference data loading, and Purchase Order EDI file operations. The ideal candidate will contribute to process improvement initiatives by gathering and documenting data management requirements for the business system processing team, reviewing and auditing complex processing workflows, and collaborating with cross-functional teams to optimize data processing for covered entities and pharmacies.
Additionally, this position requires developing expertise over time to support new CE client implementations, file, and data management quality improvement, and CPE claims processing, alongside troubleshooting data issues, ad hoc data manipulation, data or results forecasting, and report design. Partnering closely with the product team, the candidate will also contribute insights for enhancing IT operational requirements for CPE, ensuring efficiency and excellence in every aspect of TPA operations.
This candidate would also work together with developer teams, product managers, and business stakeholders/owners, collaborating with the pharmacy and client operations, sales and marketing, finance, human resources, and other internal support teams, as well as contributing to the overall vision for our annual product roadmap.
This individual will need the ability to thrive in a small company where many responsibilities and demands may be called upon in the position, where flexibility, problem-solving skills, a positive attitude, and openness to career feedback to support rapid company growth.
Key Responsibilities
Data Engineering & ETL Development
Develop and optimize AWS Glue workflows for EHR data ingestion, cleansing, and normalization.
Build Python-based ETL pipelines to process prescription claims, applying business rules for 340B eligibility and referral claims.
Manage integration of drug price files, purchase order EDI files, and reference data into RDS SQL Server.
Ensure data pipelines meet SLAs for batch processing and real-time demands.
Data file types may include: EHR files (patients, visits), EDI files for drug ordering, reference data including drug formularies, interchange files with gateways, Health exchanges or other TPA industry data partners, client invoice or other related financial information exchanges required.
Production Support & Platform Management
Monitor and troubleshoot AWS batch processing dashboards (Glue, Step Functions).
Provide Tier 2/3 support for the CPE platform, resolving data discrepancies, job failures, or performance issues.
Conduct periodic audits of processing chains to ensure data integrity and compliance with 340B requirements.
Collaborate with configuration teams to validate pharmacy/CE setup in CPE.
Client Implementation & Advisory Support
Analyze client EHR and claims data quality during new implementations, EHR conversions, or M&A activity.
Advise on eligibility models, claims logic, invoicing processes, and reporting requirements.
Support HI-Trust certification efforts by ensuring data security and audit trails.
Process Improvement & Collaboration
Partner with business analysts to document operational requirements for system enhancements.
Recommend automation opportunities (e.g., reducing manual interventions in claims processing).
Work with product teams to translate business needs into technical specifications for CPE.
Support any data infrastructure migration from old technology stacks to new, cloud-native technology stacks.
Support any process improvement or certification efforts, such as Hitrust R2, when required, through documentation or development efforts.
Data Analysis & Reporting
Manipulate large datasets to troubleshoot issues or generate ad-hoc reports for clients.
Create dashboards to track key performance indicators (KPIs) such as claims throughput, error rates, and savings.
Professional Qualities
Flexible, organized, and detail-oriented with excellent critical thinking ability.
Strong written and verbal communication skills.
Exceptional presentation skills, both in-person and online
Preferred Experience
Bachelor’s degree and 10+ years of data technology experience;
3+ years of experience with AWS Glue, S3, RDS SQL Server, and Python for ETL. (must-have)
Proficiency in SQL (complex joins, stored procedures, query optimization). (must-have)
Experience with healthcare data (EHR, pharmacy claims, HL7/EDI formats) (preferred).
Exposure to SQL Server performance tuning (preferred)
AWS Certified Data Engineer (preferred).
Snowflake SnowPro Core certification (preferred).
Knowledge of HI-Trust security standards (preferred).
Familiarity with 340B program regulations and TPA operations (preferred).
Understanding of pharmacy claims adjudication processes (preferred).
Excellent interpersonal skills including such areas as team spirit, problem resolution, collaboration, pitching in where needed, valuing and respecting individuals irrespective of seniority levels
Proven track record of improving business system processing operations
Physical Requirements
Requires the ability to sit or stand for long periods, occasional stooping, and reaching; May require lifting up to 25 pounds; requires normal range of vision and hearing with or without accommodations.
Occasional Travel may be required, to attend planning sessions, new product brainstorming, or requirements gathering
Additional Information
Clear Background Check Required.
Employment Information
Position is remote.
Benefits include health plan, dental, vision, and paid time off.
Flex time.
401k with a company match.
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