Oregon Licensed Pharmacy Analyst

Job Summary

A company is looking for a Pharmacy Clinical Review Analyst.

Key Responsibilities

• Conduct post-service audits of pharmaceutical and drug-related charges for compliance with medical records and reimbursement policies
• Analyze claims and billing documentation to identify discrepancies and inappropriate drug usage
• Request and evaluate supporting documentation to complete claim reviews while ensuring compliance with quality standards and regulations

Qualifications

• Licensed Practical Nurse (LPN) or Licensed Pharmacy Technician credential required
• Approximately 2+ years of clinical experience in a healthcare setting and 3+ years of health insurance claims review or auditing experience
• Recent experience in an inpatient IV room compounding sterile pharmaceuticals
• Strong knowledge of pharmaceuticals, drug administration, and billing practices
• Proficiency with standard computer tools and familiarity with healthcare documentation and claims processing forms