Full-Time
Pharmacy Analyst
Integrated Resources
501-1,000 employees
No salary listed
Philadelphia, PA, USA
In Person
 Medical, Clinical & Veterinary (1) |
|---|
- Bachelor's Degree
- To maintain, review, and provide consultation on basic to moderately complex customer benefits. The benefit claims analyst also analyses claims reports to identify trends, issues, and present recommendations.
- Maintains current knowledge of Medicare requirements related to Part D Chapters 5, 6, and 14 as they pertain to benefits and claims adjudication
- Researches benefit and claims related inquiries
- Makes recommendations for fulfilment of basic to moderately complex benefit requests
- Documents benefit design specifications for submission to the claims processing vendor
- Prepares test plans, scenarios, and executes testing
- Monitors and reports claims activity based upon benefit set-up to ensure accurate processing according to the approved requirements from the customer
- Troubleshoots reported claims defects and provides detailed summary of analysis and all available solutions for immediate mitigation
- Processes claims transaction requests (rework)
- Makes recommendations to management based upon trend analysis
- Reviews and writes comprehensive reports, identifies alternatives, and makes recommendations to management.
- Participation including leading of audits related to benefit or claims activity
- Performs other related duties and projects as assigned by the department Director or Regional Supervisor.
- Supports and carries out the PerformRx Mission & Values.
- Maintains a current knowledge base of PerformRx programs, services, policy and procedures.
- Regularly reviews and adheres to standard operating guidelines, desktop procedures, checklists, templates, and memorandums issued to the department.
- Creates and supports an environment which fosters teamwork, cooperation, respect and diversity.
- Establishes and maintains positive communication and professional demeanor with PerformRx employees and customers at all times.
- Demonstrates and supports commitment to corporate goals and objectives
- CPhT certification preferred
Company Size
501-1,000
Company Stage
N/A
Total Funding
N/A
Headquarters
Edison, New Jersey
Founded
1996
Simplify's Take
What believers are saying
- Certification boosts appeal to quality-focused healthcare organizations.
- Reskilling programs cut time-to-hire amid workforce shortages.
- Positions IRI among 15,000 Joint Commission-accredited elite firms.
What critics are saying
- Certification lapses in 12-18 months from failed onsite review.
- Patient complaints trigger decertification and client losses in 6-12 months.
- AMN Healthcare captures IRI's mid-sized clients in 12-24 months.
What makes Integrated Resources unique
- Joint Commission Gold Seal certifies IRI's staffing compliance since 2009.
- AI tool Nova hybridizes with reskilling to close healthcare skills gaps.
- Focuses on diversity hiring and performance monitoring for elite placements.
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Benefits
Wellness Program
Mental Health Support
Flexible Work Hours
Phone/Internet Stipend
Home Office Stipend
Conference Attendance Budget
Company News
Edison, New Jersey - Integrated Resources Inc. has earned The Joint Commission's Gold Seal of Approval(R) for Health Care Staffing Services Certification by demonstrating continuous compliance with its performance standards.
Integrated Resources Inc. has earned The Joint Commission’s Gold Seal of Approval ® for Health Care Staffing Services Certification by demonstrating continuous compliance with its performance standards.