Pharmacy Claims & Operations Analyst

New Jersey Urology•Voorhees, NJ

2d•$52,000 - $65,000

About The Position

The Pharmacy Operations & Claims Reconciliation Analyst is responsible for supporting the operational, financial, and analytical functions of USUP's pharmacy program through claims reconciliation, reimbursement analysis, operational reporting, and performance monitoring. This role serves as a key member of the Pharmacy Operations team, partnering with pharmacy leadership, cancer operations leadership, finance, contracting, and external payer/PBM partners to ensure claims accuracy, identify reimbursement opportunities, support operational decision-making, and drive continuous process improvement. This role is intended to support the continued growth of USUP's pharmacy and medically integrated dispensing programs through data-driven operational support, claims reconciliation, reimbursement monitoring, and business analytics.

Requirements

Bachelor's degree in Business, Finance, Healthcare Administration, Analytics, Pharmacy, or related field.
1–2 years of experience in pharmacy operations, healthcare operations, claims processing, healthcare analytics, medical billing, reimbursement support, or a related analytical role.
Experience working with healthcare, pharmacy, or claims data.
Proficiency in Microsoft Excel, including Pivot Tables, VLOOKUP/XLOOKUP, formulas, filtering, and data analysis.
Strong analytical, problem-solving, and organizational skills.
Strong attention to detail and commitment to data accuracy.
Ability to investigate discrepancies and communicate findings clearly.
Excellent written and verbal communication skills.
Ability to manage multiple priorities and meet deadlines.
Comfortable working cross-functionally and with external vendors.
Ability to work independently while supporting a collaborative team environment.

Nice To Haves

Experience with specialty pharmacy, physician dispensing, infusion pharmacy, oncology pharmacy, or ambulatory pharmacy operations.
Familiarity with pharmacy claims adjudication, PBM reimbursement methodologies, and payment integrity processes.
Experience supporting claims reconciliation, reimbursement analysis, or financial variance investigations.
Exposure to payer contracting, PBM contract analysis, or reimbursement modeling.
Experience developing dashboards and operational reporting.
Working knowledge of SQL for data extraction and analysis.
Experience using Power BI, Tableau, or similar reporting and business intelligence tools.
Knowledge of Medicare Part D, Medicaid, and commercial pharmacy reimbursement programs.
Understanding of NCPDP transaction standards and pharmacy claims processing.

Responsibilities

Reconcile pharmacy claims between dispensing systems, PBM remittance files, adjudication systems, vendor reports, and financial records.
Identify underpayments, overpayments, duplicate payments, reversals, and missing transactions.
Investigate reimbursement discrepancies and perform root cause analyses.
Validate claim payments against contractual reimbursement methodologies and payer agreements.
Coordinate with PBMs, payers, pharmacies, and internal stakeholders to resolve payment discrepancies.
Support recovery efforts for identified reimbursement variances and payment integrity opportunities.
Develop, maintain, and distribute operational dashboards and reports related to pharmacy performance, prescription volume, payer mix, reimbursement trends, and key performance indicators.
Analyze pharmacy operational data to identify trends, opportunities, and areas for improvement.
Monitor prescription conversion rates, referral patterns, dispensing performance, and patient access metrics.
Support pharmacy leadership with ad hoc analyses, business reviews, and strategic initiatives.
Identify and recommend process improvements that enhance operational efficiency and financial performance.
Assist in the development and monitoring of pharmacy operational KPIs and scorecards.
Monitor payer and PBM reimbursement performance across pharmacy programs.
Analyze reimbursement trends, fee structures, and contract performance.
Support pharmacy leadership in evaluating reimbursement changes and financial impacts.
Assist with payer and PBM performance reviews through data analysis and reporting.
Identify opportunities to improve reimbursement outcomes and reduce revenue leakage.
Prepare reconciliation reports, variance summaries, executive reporting, and issue logs.
Maintain detailed documentation of findings, investigations, corrective actions, and resolutions.
Support internal and external audits by providing reconciliation documentation and analytical support.
Ensure data integrity and consistency across reporting platforms and operational systems.
Assist in developing standardized reporting and reconciliation procedures.