Pharmacy High-Cost Drug Analyst

Machinify

8h • Hybrid

About The Position

The High-Cost Drug Analyst works on behalf of health plans to investigate, identify, and recover overpayments of specialty drug claims paid through medical and pharmacy systems. The Analyst will review information related to how a drug was administered and billed (e.g., billed units, intended dose, sourcing, etc.), use the online client system to better understand the related medical encounter, and confirm probable overpayments with the healthcare provider. The analyst will then work with the provider to recover the overpayment on behalf of the client.

Requirements

• Bachelor’s Degree or equivalent combination of experience in health insurance or related fields, which would provide the necessary knowledge, skills and abilities to successfully perform the work
• Professional oral and written communication skills, including excellent phone communication skills
• Comfortable working in computer applications
• Very strong critical thinking, attention to detail, and organizational skills
• Ability to work well independently or in a team environment
• Proficiency with Microsoft Word and Excel

Nice To Haves

• Medical claim billing and/or coding experience is extremely valuable, but not required
• Experience in the pharmaceutical field is helpful, but not required

Responsibilities

• Investigates to confirm that drug claims are billed and paid correctly
• Analyzes claims data and healthcare records, applying specialized knowledge of prescription drugs, provider practices, and health insurance benefit structure
• Communicates with healthcare providers and insurers to gather required information
• Utilizes all available resources to maximize identification and recovery of overpayments
• Answers phone calls in a timely fashion and resolves issues
• Creates, maintains, and closes files in accordance with policies and guidelines
• Assists with submitting overpaid claims in client vendor management systems, as needed

Benefits

• PTO
• Paid Holidays
• Volunteer Days
• Eligibility for health, vision and dental coverage
• 401(k) plan participation with company match
• Flexible spending accounts
• Tuition Reimbursement
• Eligibility for company-paid benefits including life insurance, short-term disability, and parental leave
• Remote and hybrid work options

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Number of Employees: 101-250 employees