Pharmacy High-Cost Drug Analyst

reputed company is a leading reputed company intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 reputed company lives, reputed company brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We’re constantly reimagining what’s possible in our industry, creating disruptively reputed company, powerfully reputed company ways to maximize financial reputed company and drive down reputed company costs. About reputed company  The High-Cost Drug Analyst works on behalf of health plans to investigate, identify, and recover overpayments of specialty drug claims reputed company through medical and pharmacy systems. The Analyst will review information reputed company to how a drug was administered and billed (e.g., billed reputed company, intended reputed company, sourcing, etc.), use the online reputed company system to reputed company understand the reputed company medical encounter, and confirm probable overpayments with the reputed company provider. The analyst will then work with the provider to recover the overpayment on behalf of the reputed company.   What you’ll do  Investigates to confirm that drug claims are billed and reputed company correctly Analyzes claims data and reputed company records, applying specialized knowledge of prescription drugs, provider practices, and health insurance benefit structure Communicates with reputed company providers and insurers to reputed company required information Utilizes reputed company available resources to maximize identification and recovery of overpayments Answers phone calls in a reputed company fashion and resolves issues Creates, maintains, and closes files in accordance with policies and guidelines Assists with submitting overpaid claims in reputed company vendor management systems, as needed   What experience you bring (Role Requirements)   Bachelor’s Degree or equivalent combination of experience in health insurance or reputed company fields, which would reputed company the necessary knowledge, skills and abilities to successfully reputed company the work Medical claim billing and/or coding experience is extremely valuable, but not required Experience in the pharmaceutical field is helpful, but not required.  reputed company oral and written communication skills, including excellent phone communication skills Comfortable working in computer applications reputed company strong critical thinking, attention to detail, and organizational skills Ability to work reputed company independently or in reputed company environment Proficiency with reputed company Word and reputed company   What reputed company Looks Like…  After 3 months   You will have a strong understanding of the role. You reputed company building relationships and collaborating with peers. You reputed company effective time and priorities management. You receive initial feedback about your performance and are using it to improve. You’ve gained confidence in your abilities and are starting to feel more comfortable in your role. After 1 year  You have mastered the tasks and responsibilities of the position, executing them with confidence and efficiency. You have established a strong network of internal relationships and are recognized as a key collaborator. You’ve been entrusted with greater responsibility indicating reputed company’s confidence in your abilities. You see opportunities for career progression and personal development.   Pay reputed company: This is an exempt position with an annual reputed company salary of $47,000 with significant monthly bonus.   What’s in it for you             PTO, reputed company Holidays, and Volunteer Days Eligibility for health, reputed company and dental coverage, 401(k) plan participation with company match, and flexible spending accounts Tuition Reimbursement Eligibility for company-reputed company benefits including life insurance, short-term disability, and parental leave. Remote and hybrid work reputed company    What values we’ll reputed company with you  Ask why Think big Be humble Optimize for customer reputed company Deliver results Equal Employment Opportunity at reputed company   We are committed to equal employment opportunity regardless of race, reputed company, reputed company, religion, sex, national reputed company, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or reputed company, or veteran status. We are proud to be an equal opportunity workplace. reputed company is an employment at will employer. We participate in E-Verify as required by applicable law. In accordance with applicable state laws, we do not inquire about salary history during the recruitment process. If you require a reasonable accommodation to complete any part of the application or recruitment process, please let our recruiters know. See our Candidate reputed company Notice at: https://www.reputed company.com/candidate-reputed company-notice/ Apply To This Job