Acceptance Testing, Claims Processing, Communication Skills, Consulting, Data Analysis, Data Management, Data Quality, Data Sets, Database Extract Transform and Load (ETL), Electronic Data Interchange (EDI), Failure Analysis, Healthcare, Network Switching, Onboarding, Pharmacy, Power BI, Quality Metrics, Reporting Dashboards, Root Cause Analysis, SQL (Structured Query Language), Service Level Agreement (SLA), Tableau, Telecommunications Standards, Transaction Processing/Management
Job Title: Senior Consultant Pharmacy Data Management & Analytics
Location: Remote (USA)
Employment Type: Contract
About the Role
We are seeking an experienced Senior Consultant with a strong background in pharmacy data management, pharmacy claims processing, PBM operations, and NCPDP transaction standards. This role will support a strategic pharmacy data modernization initiative focused on migrating pharmacy transaction standards from NCPDP D.0 to NCPDP F6.
The ideal candidate will serve as a subject matter expert, working closely with data architecture teams, PBMs, pharmacy switch networks, pharmacies, and external vendors to ensure successful migration, compliance, data quality, and transaction integrity.
Key Responsibilities
Serve as the SME for migration from NCPDP D.0 to NCPDP F6 transaction standards.
Validate NCPDP F6 compliance, transaction routing, and telecommunication standards.
Develop and maintain data mappings, crosswalks, and business rules for D.0 to F6 conversion.
Lead testing activities including UAT, compliance validation, and transaction certification.
Coordinate supplier and vendor re-onboarding activities across pharmacies, PBMs, switch networks, and external data providers.
Troubleshoot transmission issues, claim rejections, connectivity problems, and data anomalies.
Monitor SLAs related to data quality, transaction processing, and supplier migration progress.
Build dashboards and reports to track migration health, transaction volumes, rejection rates, and data quality metrics.
Perform root cause analysis for transaction failures, mapping issues, and claims processing errors.
Collaborate with data engineering teams to optimize data ingestion, ETL processes, and analytics platforms.
Required Qualifications
7+ years of experience in healthcare data management, pharmacy claims, PBM operations, or pharmacy technology environments.
Hands-on experience with NCPDP Telecommunication Standards, particularly NCPDP D.0 and NCPDP F6.
Strong understanding of pharmacy claims processing, claim routing, and transaction compliance.
Experience working with PBMs, pharmacies, pharmacy switch vendors, and healthcare data suppliers.
Strong SQL skills and experience analyzing large healthcare or pharmacy datasets.
Experience with reporting and analytics tools such as Tableau or Power BI.
Experience reviewing transaction logs, rejection files, telecom transaction strings, and claims data.
Ability to translate technical specifications into business and technical requirements.
Strong communication and stakeholder management skills.
Preferred Qualifications
Experience with NCPDP F6 certification and testing environments.
Prior involvement in pharmacy transaction modernization or migration programs.
Experience with healthcare EDI transactions and compliance reporting.
Knowledge of pharmacy switch vendors such as Surescripts, RelayHealth, Change Healthcare, or similar platforms.
Experience with data quality monitoring, governance, and migration reporting.