PBM Data Integration Analyst

We are seeking a highly experienced PBM Data Integration Specialist with strong expertise in pharmacy benefit management (PBM) systems and payer integrations. The ideal candidate will have deep knowledge of NCPDP standards, specifically transitioning and mapping data from D0 to F6 formats, and a strong understanding of how these datasets are utilized across payer and PBM ecosystems. Key Responsibilities: • Lead the mapping and transformation of NCPDP data files from D0 to F6 formats. • Collaborate with payer clients and PBM stakeholders to ensure accurate data exchange and integration. • Analyze and interpret complex PBM datasets and workflows to support seamless data processing. • Design, document, and validate data mappings, transformations, and business rules. • Ensure compliance with NCPDP standards and industry best practices. • Troubleshoot data discrepancies and integration issues between PBM and payer systems. • Work closely with cross-functional teams including IT, data engineering, and business stakeholders. • Provide guidance on how NCPDP files are utilized, transmitted, and processed across systems. Required Qualifications: • Strong experience in Pharmacy Benefit Management (PBM) domain. • Hands-on experience working with payer clients on data integration initiatives. • Deep expertise in NCPDP standards, especially D0 and F6 transaction formats. • Strong understanding of healthcare data exchange and claims processing workflows. • Experience in mapping, transforming, and validating large healthcare datasets. • Excellent analytical and problem-solving skills. • Strong communication skills with the ability to work with technical and business stakeholders. Preferred Qualifications: • Experience with healthcare EDI transactions and data integration tools. • Familiarity with claims adjudication and pharmacy billing processes. • Prior experience in payer-PBM integration projects. • Knowledge of HIPAA compliance and healthcare data regulations. Key Skills: • NCPDP D0 & F6 expertise • PBM systems and workflows • Payer integration • Data mapping & transformation • Healthcare data standards • Stakeholder communication