PBM Claims Analyst - Guaynabo PR

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    "requisitionDescription": "<p data-pasted=\"true\"><strong>Location: Guaynabo, PR</strong>&nbsp;</p><p>PBM Claims Analyst is responsible for auditing, analyzing, and tracking accounts receivable related to Pharmacy Benefit Managers (PBMs) at a specialty pharmacy. This role focuses primarily on reviewing and validating payments, identifying discrepancies, and analyzing unpaid payments. The analyst&rsquo;s primary responsibility is to audit, document, and report findings to the teams.&nbsp;</p><p><br></p><p data-pasted=\"true\"><strong>Responsibilities:&nbsp;</strong></p><ul><li>Conduct daily audits of PBM-related accounts receivable to identify outstanding balances.</li><li>Analyze claims that have been paid, partially paid, or unpaid, as processed in &ldquo;View Response.&rdquo;</li><li>Review PBM remittances, reports, and electronic files to verify the accuracy of payments.</li><li>Identify discrepancies between amounts billed, amounts paid, and contractually expected amounts.</li><li>Clearly and thoroughly document audit findings in the established systems.</li><li>Refer cases of errors, partial payments, or required adjustments to the Operations team.</li><li>Follow up on referred cases until resolution, without performing reprocessing.</li><li>Prepare lists and reports of audited and referred PBM accounts and discuss them with your Supervisor.</li><li>Identify recurring patterns of errors, delays, or non-compliance by PBMs.</li><li>Communicate financial trends and risks to the appropriate Supervisor or Manager.</li><li>Support internal and external audits related to PBM accounts receivable.</li></ul><p><br></p><p data-pasted=\"true\"><strong>Requirements:&nbsp;</strong></p><ul><li>Associate&#39;s degree in Medical Billing and Coding, Health Services Administration, Medical Office Administration, Medical Records, or related fields in the healthcare sector.</li></ul><p><br></p><p>***Equal Opportunity Employer M/F/V/D**</p>\n",
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