Lead Pharmacy Payment Integrity Analyst

SmartLight Analytics

Lead Pharmacy Payment Integrity Analyst at SmartLight Analytics improving patient outcomes and supporting healthcare decision-making. Analyze Pharmacy data for actionable insights in claims processing and cost-effective healthcare payments.

Posted 5/30/2026full-timeTexas • 🇺🇸 United StatesSeniorWebsite

About the role

Key responsibilities & impact

Identify Pharmacy billing activities leading to improper payments.
Review Pharmacy claims, insured members, or the broker community in coordination with the customer’s carrier or third-party administrator
Review claims data and conduct analysis to look for patterns of potential improper payments
Utilize information from claims data analysis, plan members, and other sources to conduct confidential claims data reviews, relevant investigative activities, document actionable findings and report any suspect billing that could result in an overpayment through designated channels
Conduct data analysis to review claim and case history
Review claims history, provider files, etc. and utilize data analysis techniques to detect irregularities, billing trends, and financial relationships using state boards, licensing sites, Secretary of State sites, etc.
Identify and resolve issues related to data discrepancies, missing data, or inconsistencies within clinical datasets

Requirements

What you’ll need

Bachelor's degree or 4 – 6 years of equivalent work experience in healthcare administration, billing, Pharmacy claims adjudication, Pharmacy auditing, payment integrity operations and/or healthcare reimbursement, CPhT, CPC, CCS or other relevant clinical/Pharmacy/coding certifications strongly preferred.
Strong knowledge of clinical terminology, medical procedures, Pharmacy 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

Benefits

Comp & perks

health insurance
retirement plans
paid time off
flexible work arrangements
professional development
bonuses
stock options
equipment allowances
wellness programs

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

data analysisclaims data reviewbilling analysisPharmacy claims adjudicationPharmacy auditingpayment integrity operationshealthcare reimbursementclinical data analysisirregularity detectionfinancial relationship analysis

Soft Skills

detail-orientedexcellent communication skillsinterpersonal skillscritical-thinkingindependent decision-makingconcisenessdefensible decision-makingattention to detail

Certifications

CPhTCPCCCS