Pharmacy Payment Integrity Analyst

Job Summary

Working remotely in a full-time capacity, the Lead Pharmacy Payment Integrity Analyst will analyze Pharmacy data to provide insights for improving patient outcomes, ensure accurate claims processing, and support healthcare decision-making while preventing overpayments.

Key responsibilities

• Identify waste and inaccurate Pharmacy claims through data analysis and review of billing activities
• Utilize AI and predictive analytics to uncover patterns and drive smarter decision-making
• Conduct confidential claims data reviews and document actionable findings related to potential overpayments

Required qualifications

• Bachelor's degree or 4 - 6 years of equivalent work experience in healthcare administration, billing, or payment integrity operations
• CPhT, CPC, CCS, or other relevant clinical/Pharmacy/coding certifications strongly preferred
• Strong knowledge of clinical terminology, medical procedures, and Pharmacy workflows
• Ability to provide concise and defensible decisions in writing
• Detail-oriented with a strong analytical skill set for interpreting complex data