Pharmacy Claims Analyst

Job Summary

A company is looking for a Claims Analyst - Pharmacy Revenue Cycle.

Key Responsibilities

• Ensure grievances and appeals are accurate and well-documented for processing and resolution
• Review and appeal denials, utilizing knowledge of coding systems and prior authorization processes
• Collaborate with pharmaceutical companies on reimbursement and treatment guidelines

Required Qualifications

• Bachelor's degree in Business, Healthcare, or a related field, or equivalent work experience
• Preferred certifications include Certified Pharmacy Technician and coding certifications (CPC, RHIT)
• 5-7+ years of experience in healthcare, coding, finance, or revenue cycle, preferably in a Medical Center or Oncology setting
• Strong knowledge of claim edits and Medicare billing procedures
• Ability to analyze and interpret complex medical and billing terminology