Pharmacy Claims Analyst

Job Summary

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

Key Responsibilities

• Research, resolve, and prepare claims that have not passed payer edits and determine actions to resolve rejected drug claims
• Serve as a subject matter expert for provider relationships, service issues, reimbursement, and claims
• Monitor rejections on electronic and paper claims to identify necessary enhancements or fixes in system edits

Required Qualifications

• Bachelor's degree in Business, Healthcare or a closely related field, or equivalent work experience
• Certified Pharmacy Technician preferred; Coding Certification CPC, RHIT preferred
• 1 to 3 years of experience in healthcare, coding, finance, revenue cycle, patient accounting, or physician billing
• Advanced working knowledge of professional billing flows and revenue cycle tasks
• Strong knowledge of claim edits, CPT/HCPCS, ICD-10-CM-PCS diagnosis codes, and drug NDC numbers