Senior Business Analyst – Pharmacy (RCM, Billing & Financial Reconciliation)

Overview

We are seeking a highly experienced Senior Business Analyst with deep expertise in specialty/infusion pharmacy, medical billing, and financial reconciliation to support enterprise SaaS implementations. This role serves as a critical liaison between clients, operations, product, and engineering teams to define business requirements, design future-state workflows, and ensure successful delivery of Revenue Cycle Management (RCM) solutions.

The ideal candidate brings strong domain knowledge in pharmacy billing, claims adjudication, payment posting, and reconciliation, and plays a key role across the full client lifecycle—from pre-sales through implementation and post-go-live optimization.

Key Responsibilities

Delivery & Strategic Execution

• Lead complex and enterprise-wide implementations with multiple integrated workstreams
• Own RCM functional track deliverables, ensuring alignment across stakeholders
• Define governance standards, implementation plans, and risk mitigation strategies
• Drive future-state workflow design across pharmacy operations and revenue cycle processes
• Manage release coordination, dependencies, and cross-functional execution

Pharmacy Billing & Revenue Cycle Expertise

• Serve as Subject Matter Expert (SME) in:
• Medical and pharmacy billing (specialty and infusion)
• Claims lifecycle management (submission, adjudication, reversals, rebilling)
• Payment posting, ERA (835), and financial reconciliation
• Optimize workflows to improve:
• Clean claim rate and first-pass yield
• Denial management and resolution
• Days in Accounts Receivable (A/R)
• Net collections and revenue leakage prevention
• Analyze and resolve billing discrepancies including underpayments, overpayments, and unapplied cash
• Ensure alignment between pharmacy systems, billing platforms, clearinghouses, and financial systems

Client Engagement & Product Collaboration

• Work closely with clients to gather and define RCM and operational requirements
• Translate client needs into business and system requirements for product development
• Provide business case justification for product enhancements
• Participate across the full lifecycle:
• Request for Proposal (RFP) responses and product demos
• Implementation, testing, and go-live
• Post-production support and optimization
• Partner with Product Managers on roadmap and knowledge sharing

Requirements & Process Analysis

• Elicit, document, and manage business and system requirements (BRDs, design documents)