Pharmacy Payment Integrity Analyst

Job Summary

A company is looking for a Lead Pharmacy Payment Integrity Analyst.

Key Responsibilities

• Identify waste and inaccuracies in Pharmacy claims
• Analyze claims data to detect patterns of potential improper payments
• Conduct confidential claims data reviews and document actionable findings

Required Qualifications

• Bachelor's degree or 4 - 6 years of equivalent work experience in healthcare administration or related fields
• Relevant clinical/Pharmacy/coding certifications such as CPhT, CPC, or CCS preferred
• Strong knowledge of clinical terminology and healthcare workflows
• Intermediate knowledge of Local, State & Federal health insurance laws and regulations is a plus
• 3+ years of experience in the group health business with a focus on pharmacy is a bonus