Claims Analyst Pharmacy Revenue Cycle in Boston, Massachusetts - #72971 | VanderHouwen

Description

Job Id: 72971

Claims Analyst – Pharmacy Revenue Cycle
Our client is seeking a detail-oriented Claims Analyst to join their Pharmacy Revenue Cycle team. This role plays a key part in ensuring accurate reimbursement for pharmaceutical services by investigating, analyzing, and resolving complex claims issues. The ideal candidate will bring strong knowledge of medical billing processes, regulatory guidelines, and pharmacy workflows, combined with analytical problem-solving skills and clear communication.

This role is fully remote.

Claims Analyst Responsibilities

• Research and resolve rejected or underpaid pharmacy claims, ensuring accuracy in coding, billing, and contract terms.
• Monitor payer edits and electronic/paper claim rejections, recommending system or workflow improvements to reduce denials.
• Serve as a subject matter resource for provider relations, reimbursement practices, and claims resolution.
• Review and interpret prescription drug orders, applying medical and billing terminology knowledge.
• Collaborate with pharmacy, finance, and revenue cycle teams to reduce denials and avoidable write-offs.
• Apply regulatory knowledge of Medicare, commercial payer rules, and coding standards to assess billing accuracy.
• Investigate compliance issues, denials, inappropriate coding, and reimbursement variances.
• Provide analysis and reporting on claim rejection metrics and revenue recovery opportunities.
• Conduct timely follow-up on outstanding balances, focusing on maximizing reimbursement and client satisfaction.
• Support education and feedback efforts across departments on pharmacy revenue cycle processes and performance indicators.

Claims Analyst Qualifications

• Bachelor’s degree in Business, Healthcare, or related field, or equivalent work experience.
• 1–3 years of experience in healthcare, coding, billing, revenue cycle, or pharmacy/infusion settings.
• Certified Pharmacy Technician (CPhT) or coding certification (CPC, RHIT) preferred.
• Strong knowledge of billing flows, payer edits (NCCI, MUE), and Medicare billing unit conversions for pharmacy drugs.
• Familiarity with CPT, HCPCS, ICD-10, and NDC coding standards.
• Advanced analytical skills with ability to evaluate complex claims and reconcile accounts.
• Experience working in Epic or similar healthcare billing systems.
• Strong interpersonal and communication skills, with ability to collaborate across departments and present findings effectively.
• Detail-oriented, organized, and able to interpret data into actionable solutions.

Compensation: $30-$35/hr. (DOE)

VanderHouwen Contractors Enjoy Exceptional Benefit Perks!
As an eligible contract employee with VanderHouwen, you’ll have access to a full suite of benefits designed with your well-being in mind. Our comprehensive package includes medical, dental, vision, life insurance, short- and long-term disability, and a matching 401(k) to help secure your future.

Meet VanderHouwen
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VanderHouwen is an award-winning, Women & Diversity-Owned, WBENC certified professional staffing firm. Founded in 1987, VanderHouwen places experienced professionals across the nation! Our recruitment teams specialize in either Technology and IT, Engineering, Human Resources, or Accounting and Finance career markets. Partner with us to land your next exciting career!

VanderHouwen is an Equal Opportunity Employer and participates in E-Verify. VanderHouwen does not discriminate based on race, color, religion, sex, national origin, age, disability, or any other characteristic protected by applicable local, state, or federal civil rights laws.

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