Ohio Licensed Pharmacy Claims Analyst

Job Summary

A company is looking for a Pharmacy Lead Claims Review Analyst.

Key Responsibilities

• Assist the Claims Manager with daily operations of the Concurrent and Desk Claims Review programs
• Develop and periodically review educational documents and workflows to ensure they meet business objectives
• Lead both prepayment and postpayment claims teams and manage the Concurrent Claims Review program

Required Qualifications

• Bachelor's degree in business, audit, healthcare, or related field preferred, or equivalent work experience
• 2 years of experience in a claims analytical, claims processing, benefit configuration, or QA/auditing role in healthcare required
• Understanding of pharmacy claims payment configuration processes and systems
• Knowledge of pharmacy claims processing
• Nationally Certified Pharmacy Technician