RITE AID · 2 days ago

Sr Analyst, Payer Compliance

Remote- United States

Full-time

Remote

Senior Level

$74K/yr - $106K/yr

5+ years exp

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Responsibilities

Manage Internal Claim Review process through continual maintenance of database, drug product list, and drug product error parameters.

Analyze pre-dispensed prescription claim level data, build queries, maintain analyses, models, and dashboard to improve pharmacy claims accuracy to reduce potential audit chargebacks.

Analyze and Identify patterns of post-dispensed prescription billing errors through analysis of prescription claim data, previous PBM audit findings, and drug product research. Effectively compile and communicate findings to leadership or stakeholders verbally, visually, and in writing.

Collaborate with internal business units to propose and help put in place system enhancements to reduce prescription billing errors.

Work with field leaders, audit companies, and PBM’s to proactively remediate and resolve audit issues as it pertains to claim billing, audits, and the drug dispensing process.

Support special projects/initiatives, produce routine and ad hoc reports to compile audit statistics to aid in management decision making.

Adaptable, open to change, and able to work in ambiguous situations and respond to new information or unexpected circumstances.

Qualification

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Business AnalysisAdvanced Microsoft ExcelFinancial AnalysisOperational AnalysisPBM ExperienceData AnalysisVBAMacro codeSQLHTMLPHPTableauHealthcare ExperienceRetail Pharmacy Experience