Pharmacy Program Optimization Analyst

Pharmacy Program Optimization Analyst
Full Time
Columbus, Ohio

AndHealth is on a mission to radically improve access and outcomes for the most challenging chronic health conditions with the goal of making world-class specialty care accessible and affordable to all. We partner with health systems, community health centers, plans, and employers to remove barriers to care to ensure all people have access to the care they deserve.


We are looking for a Pharmacy Program Optimization Analyst who will play a critical role in maximizing the efficiency and effectiveness of our partner’s federal drug pricing programs. This individual will move beyond traditional compliance, focusing on identifying and implementing opportunities for significant program enhancement and revenue capture across multiple pharmacy claim initiatives.

You will apply strong analytical skills to identify inefficiencies, uncover missed opportunities, and improve performance across pharmacy claims and operational workflows. While this role operates in a regulated healthcare environment, prior healthcare experience is not required. We value analytical thinking, adaptability, and a willingness to learn complex domains.

What you’ll do in the role:

• 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.

Education & Licensure Requirements:

• Bachelor’s degree in Analytics, Computer Science, Economics, Engineering, Mathematics, or a related quantitative field — or equivalent practical experience.

Other Skills or Qualifications:

• 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.
• 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.

Here’s what we’d like to offer you:

• Equal investment and support for our people and patients.
• A fun and ambitious start-up environment with a culture that takes on important things, takes risks, and learns quickly.
• The ability to demonstrate creativity, innovation, and conscientiousness, and find joy in working together.
• A team of highly skilled, incredibly kind, and welcoming employees, every one of whom has something unique to offer.
• We know that the overall success of our business is a collaborative effort, and we strive to provide ongoing opportunities for our employees to learn and grow, both personally and professionally.
• Full-time employees are eligible to participate in our benefits package which includes Medical, Dental, Vision Insurance, Paid time off, Short- and Long-Term Disability, and more.

We are an equal opportunity and affirmative action employer. We embrace diversity and are committed to creating an inclusive environment for all employees. Applicants will be considered for employment without regard to race, religion, gender, gender identity, sexual orientation, national origin, age, disability, or veteran status.