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PBM Data Integration Specialist (NCPDP D0 to F6) - REMOTE

Software Technology Inc -
Remote

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Job Details

Contract

Qualifications

Healthcare claims management
Systems integration
Data Integration (Data management)
Working with clients on health informatics projects
Data validation techniques
Health information data integrity
Schema mapping design
Project stakeholder communication
Cross-functional communication

Full Job Description

Job Title: PBM Data Integration Specialist

Location: Remote

Client – PSG

Hiring Manager Notes

I need Someone with PBM experience - working with a payer client to help map the NCPDP file from D0 to F6 ... They need a deep knowledge of the data set and how these files are used by various clients in their integration / passed back and forth between the PBM and the payer.

Job Title: PBM Data Integration Specialist (NCPDP D0 to F6)

Location: Remote
Employment Type: Contract

Job Summary:
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

Quick Apply

Refine Your Search

Data Processing Specialist jobs

PBM Data Integration Specialist (NCPDP D0 to F6) - REMOTE

Administrative Specialist, Data Entry & Docketing (entry level)

RCM Billing Specialist

Document Control Specialist

Healthcare Data Entry Specialist - Remote US

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Payroll Specialist

Financial Specialist

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Closeout Coordinator / NJ Prevailing Wage Compliance Specialist

Tax expert/ CPA

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Accounting Specialist

Fluid Power Specialist (3+ yrs req.)

Payroll Specialist (Part-Time)

Senior Records Specialist

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