Claims Analyst

Trillium Professional is now seeking a Claims Analyst for a contract, remote position in Boston!


The assignment will last for 13 weeks. Schedule will be 40 hours per week. The pay rate is $38.22/hour.


The Claims Analyst - Pharmacy Revenue Cycle is responsible for managing complex pharmacy insurance claims, denials, and reimbursement issues to maximize revenue and ensure compliance with Medicare, commercial payer, and regulatory billing requirements. Working under the Revenue Cycle Supervisor, this individual researches denied and rejected claims, pursues insurance payments, analyzes reimbursement discrepancies, and collaborates with pharmacy and revenue cycle teams to improve billing accuracy and reduce claim rejections. This role requires strong analytical skills, healthcare billing expertise, and knowledge of pharmacy revenue cycle operations.


Key Responsibilities
-Research, analyze, and resolve rejected or denied pharmacy claims.
-Follow up with insurance companies regarding unpaid and underpaid claims.
-Review reimbursement issues, payer edits, and billing discrepancies.
-Interpret prescription drug orders and pharmacy billing documentation.
-Monitor claim edits and recommend workflow improvements to reduce denials.
-Ensure compliance with Medicare, commercial payer, and regulatory billing requirements.
-Process and monitor claims within Epic.
-Serve as a subject matter expert for complex denials, payment variances, fee schedules, and reimbursement issues.
-Collaborate with pharmacy and revenue cycle teams to improve collections and reduce avoidable write-offs.


Apply now!


Required Qualifications
-Bachelor's degree in Business, Healthcare, or related field (or equivalent experience).
-1-3 years of experience in healthcare revenue cycle, coding, medical billing, patient accounting, or physician billing.
-Experience in a hospital, medical center, oncology, infusion, or specialty pharmacy environment preferred.


Strong knowledge of:
-Medicare and commercial payer billing
-CPT, HCPCS, and ICD-10 coding
-NCCI and MUE edits
-CMS-1500 claim forms
-Drug NDC numbers and Medicare billing unit conversions
-Epic billing workflows


Preferred Certifications
-Certified Pharmacy Technician (CPhT)
-CPC or RHIT Coding Certification


Trillium has been recruiting and placing professionals for over 30 years. From Fortune 100 companies to small businesses, our philosophy remains the same: to achieve excellence by providing quality employees and an uncompromising level of service. We believe in honesty, integrity, and a simple philosophy of providing value to our customers and our employees. We strive to be unsurpassed in the recruitment and placement of quality and skilled professionals. Trillium is an Equal Opportunity Employer.