SmartLight Analytics

Lead Pharmacy Payment Integrity Analyst

SmartLight Analytics

full-time

Posted on:

Location Type: Remote

Location: United States

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Job Level

Senior

About the role

  • Identify and investigate healthcare billing activities leading to improper payments
  • Review claims data and conduct analysis to look for patterns of potential improper payments
  • Conduct data analysis to review claim and case history
  • Identify and resolve issues related to data discrepancies, missing data, or inconsistencies within clinical datasets

Requirements

  • Bachelor's degree or 4 – 6 years of equivalent work experience in healthcare administration, billing, claims adjudication, clinical auditing, payment integrity operations and/or healthcare reimbursement
  • CPC, CCS or other relevant clinical/coding certifications strongly preferred
  • Strong knowledge of clinical terminology, medical procedures, and healthcare workflows
  • Ability to be concise, independent and provide defensible decisions in writing
  • Detail-oriented with excellent communication skills (oral presentations and written) and interpersonal skills
  • Strong critical-thinking, communication and attention to detail skills
  • 3+ years of experience working in the group health business or experience in a healthcare provider’s practice
Benefits
  • Health insurance
  • Retirement plans
  • Paid time off
  • Flexible work arrangements
  • Professional development
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
data analysisclaims adjudicationclinical auditingpayment integrity operationshealthcare reimbursementhealthcare billingpattern analysisclinical datasetsdata discrepanciesmedical procedures
Soft Skills
detail-orientedcommunication skillsinterpersonal skillscritical-thinkingindependenceconcisenessdefensible decision makingattention to detail
Certifications
CPCCCS