Clinical Review Pharmacy Analyst - Cpht - R-3806_40483885656_3-4185

at Cambia Health Solutions in Lewiston, Idaho, United States

Job Description Clinical Review Pharmacy Analyst - CPhT
Telecommute Option - Must Reside within ID, OR, UT or WA
The Clinical Review Pharmacy Analyst utilizes knowledge of drugs and pharmaceuticals to conduct post service audits to ensure accuracy of billed charges.
Normally to be proficient in the competencies listed above
A Clinical Review Pharmacy Analyst would have:

• A license/certification as a Pharmacy Technician
  
• 2 years of experience in hospital or residential treatment facility
  
• 3 years of health insurance claims experience or analytical experience
  
• Or equivalent combination of education and experience.
  
• Payment review or coding experience is a plus.
  

Required Licenses, Certifications, Registration, Etc.
Licensed Pharmacy Technician
YOUR ROLE:

• Prioritizes work, sets goals, and coordinates own activities to ensure that record reviews are performed so that timely audits can be performed according to the team's workflow.
  
• Utilizes knowledge and experience to analyze billings to determine if charges are consistent with medical records, medical for drugs/pharmaceuticals and reimbursement policies. Identifies additional information needed and requests it when appropriate. May perform activities that require evaluation or interpretation of information related to drug administration and treatments.
  
• Follows strict guidelines to ensure all work meets corporate standards for accuracy, timeliness, quality and compliance with federal, state, BCBSA and accreditation regulations. Organizes and keeps readily accessible all reference documents, policies and procedures needed to accomplish this.
  
• Follows through on all assigned work; performs at a level meeting production requirements and quality standards.
  
• Contributes to the efficiency of the department by being flexible and cross-trained on other functions.
  
• Performs projects as requested by the supervisor.
  

WHAT YOU BRING:

• Demonstrated competency in claim review and experience using billing and claims forms.
  
• In-depth knowledge of drugs and pharmaceuticals to identify incorrectly billed medications, IV fluids and identify use of drugs for non-FDA approved treatments for investigational and off-label uses/administration.
  
• Familiarity with health care documentation and effective oral and written communication skills.
  
• Demonstrated initiative and strong problem-solving skills.
  
• Demonstrated ability to consistently meet productivity and quality standards with minimal support.
  
• Ability to work in fast-paced, multi-tasking, fluid environment with ever-changing priorities.
  
• General computer skills (Microsoft Office, Outlook, Internet search).
  

The expected hiring range for Clinical Review Pharmacy Analyst is $60.5k-$81.5k depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. The bonus target for this position is 10%. The current full salary range for this role is $56.5k Low MPZ / $71k MRP / $92.5 High MPZ].
Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights:

• medical, dental, and vision coverage for employees and their eligible family members
  
• annual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)
  
• paid time off varying by role and tenure in addition to 10 company holidays
  
• up to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)
  
• up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)
  
• one-time furniture and equipment allowance for employees working from home
  
• up to $225 in Amazon gift cards for participating in various well-being activities. for a complete list see our External Total Rewards page.
  

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.
If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site. To view full details and how to apply, please login or create a Job Seeker account