Pharmacy Analyst

Responsibilities:

• Provide oversight and coordination of pharmacy reimbursement operations, third-party billing, audits, and compliance activities.
• Perform day-to-day functions of pharmacy revenue cycle, prioritizing work in coordination with pharmacy leadership.
• Collaborate with pharmacy operations, finance, and billing teams to standardize processes and resolve medication-related claim issues.
• Support standardization and work to optimize the performance of insurance benefit verification, prior authorization preparation/submission, and appeals for pharmacy claims workflows.
• Process and submit accurate claims for medications, ensuring proper use of HCPCS/CPT codes, revenue codes, billable units, modifiers, and multipliers.
• Manage claim rejections, denials, and underpayments; investigate root causes and implement corrective actions to maximize reimbursements.
• Oversee charge capture, billing workflows, and collections to optimize cash flow and minimize outstanding accounts receivable.
• Ensure timely and accurate submission of primary and secondary prescription claims.
• Manage all third-party payor audits, including timely preparation, coordination, reporting, and escalation for appeal.
• Conduct scheduled and ad-hoc audits of pharmacy billing, charging, and collection practices to ensure alignment with payer contracts, Medicare/Medicaid guidelines, HIPAA, and other federal/state regulations at the direction of the Manager.
• Review claims, remittance advices, and documentation for accuracy, completeness, and compliance (including 340B program auditing where applicable).
• Prepare audit reports, findings, and recommendations; track corrective action plans and monitor ongoing compliance.

Qualifications:

• Associate degree required.
• 5 years of pharmacy experience in a healthcare environment.
• Hands-on experience with claims processing, denial management, prior authorizations, and compliance audits.
• Experience with 340B programs, HCPCS/CPT coding, and payer-specific guidelines (Medicare, Medicaid, commercial insurers).

Here is more information:

Position: Pharmacy Analyst

Term: 6 month contract with possible extension

Schedule: Onsite, Monday-Friday 8am-5pm CST

Location: Chicago, IL 60612

Pay: $35-50/hr