Clinical Review Pharmacy Analyst in Portland, Oregon - #71866 | VanderHouwen

Description

Job Id: 71866

Clinical Review Pharmacy Analyst
Our client is seeking a Clinical Review Pharmacy Analyst to support post-service claim audits and ensure the accuracy and compliance of pharmaceutical billing. This role leverages strong knowledge of medications, healthcare documentation, and reimbursement policies to evaluate claims and identify discrepancies. The ideal candidate is detail-oriented, analytical, and able to manage competing priorities while maintaining high standards of accuracy and regulatory compliance.

This role is fully remote. Applicants who reside in Oregon, Washington, Utah, or Idaho are preferred.

Clinical Review Pharmacy Analyst Responsibilities

• Conduct detailed post-service audits of pharmacy-related claims to ensure billed charges align with medical records, drug administration documentation, and reimbursement policies.
• Analyze pharmaceutical billing and treatment documentation to identify discrepancies, incorrect charges, or use of medications outside approved treatment guidelines.
• Request and review additional documentation when necessary to validate claims and support audit findings.
• Maintain compliance with regulatory, accreditation, and organizational standards while ensuring work meets established accuracy, quality, and turnaround expectations.
• Manage assigned audit workload independently, prioritizing tasks to meet productivity goals and departmental timelines.
• Maintain organized access to policies, procedures, and reference materials needed to perform claim and billing reviews effectively.
• Contribute to operational efficiency by supporting cross-functional tasks, participating in departmental initiatives, and assisting with special projects as assigned.

Clinical Review Pharmacy Analyst Qualifications

• Licensed Practical Nurse (LPN) or Licensed Pharmacy Technician certification required.
• 5+ years of combined experience in healthcare claims review, pharmacy billing analysis, or related healthcare auditing functions.
• Minimum of 2 years of clinical or healthcare facility experience (hospital or residential treatment setting preferred).
• Strong knowledge of pharmaceuticals and drug administration practices, including the ability to identify inappropriate billing, off-label use, or investigational treatments.
• Experience reviewing healthcare claims and billing documentation, with familiarity in medical records and reimbursement policies.
• Demonstrated ability to work independently, meet productivity and quality standards, and manage multiple priorities in a fast-paced environment.
• Strong analytical, problem-solving, and communication skills.
• Proficiency with Microsoft Office and general computer applications.
• Experience using AI tools or technology to support analysis and decision-making is highly preferred.
• Payment review, medical coding, or audit experience is a plus.

Compensation: (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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