PBM Claims Analyst is responsible for auditing, analyzing, and tracking accounts receivable related to Pharmacy Benefit Managers (PBMs) at a specialty pharmacy. This role mainly focuses on reviewing and validating payments, identifying discrepancies, and analyzing unpaid claims. The analyst audits, documents, and reports findings to relevant teams.
Responsibilities include conducting daily audits of PBM-related accounts receivable to identify outstanding balances, analyzing claims paid, partially paid, or unpaid, reviewing PBM remittances and electronic files for payment accuracy, identifying discrepancies in billing and payments, documenting audit findings thoroughly, referring errors or issues to Operations, following up on cases until resolution, preparing audit reports, identifying recurring error patterns, communicating financial risks, and supporting internal/external audits related to PBM accounts receivable.
Requirements:
Associate's degree in Medical Billing and Coding, Health Services Administration, Medical Office Administration, Medical Records, or related healthcare fields.
Equal Opportunity Employer M/F/V/D
- Associate's degree in Medical Billing and Coding, Health Services Administration, Medical Office Administration, Medical Records, or related healthcare fields
- Experience or knowledge in pharmacy benefit management and claims auditing preferred
Location
N/A
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
2 weeks ago