Pharmacy Payment Integrity Analyst
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Job Description
Pharmacy Payment Integrity Analyst analyzing healthcare data for improved patient outcomes and optimizing clinical workflows. Role involves claims processing, policy interpretation, and regulatory alignment.
Responsibilities:
- Identify and investigate healthcare billing activities leading to improper payments
- Review claims data and conduct analysis to look for patterns of potential improper payments
- Conduct data analysis to review claim and case history
- Review claims history, medical reviews, provider files, etc.
- Identify and resolve issues related to data discrepancies, missing data, or inconsistencies within clinical datasets
Requirements:
- Bachelor's degree or 4 – 6 years of equivalent work experience in healthcare administration, billing, claims adjudication, clinical auditing, payment integrity operations and/or healthcare reimbursement
- CPC, CCS or other relevant clinical/coding certifications strongly preferred
- Strong knowledge of clinical terminology, medical procedures, and healthcare workflows
- Detail-oriented with excellent communication skills (oral presentations and written) and interpersonal skills
- Strong critical-thinking, communication and attention to detail skills
Benefits:
- Health insurance
- Retirement plans
- Paid time off
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