Certified Pharmacy Claims Analyst

Job Summary

A company is looking for a Pharmacy Claims Analyst.

Key Responsibilities

• Analyze pre-payment pharmacy claims data to identify overpayments and ensure accurate claims processing
• Audit pharmacy claims and documentation for reimbursement accuracy based on contract terms
• Investigate claims issues and communicate with stakeholders to resolve discrepancies

Required Qualifications

• Must be a Nationally Certified Pharmacy Technician (CPhT)
• At least 2 years of experience in claims analysis, processing, or auditing in healthcare
• Experience in managed care, insurance, or pharmacy benefit management preferred
• Proficiency with pharmacy claims payment systems and MS Office, especially Excel and Access
• Ability to recognize data discrepancies and perform root cause analysis