Pharmacist

 

Description:

We are looking for a Pharmacist with strong expertise in US healthcare coverage, prior authorization, and billing processes to join our team. This role involves reviewing and analyzing insurance drug coverage policies to extract criteria, coding requirements, and rules for medicines under both medical and pharmacy benefits.

 

The selected candidate will work onsite in Pakistan, supporting a US-based healthcare services company.

 

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Key Responsibilities

 

🔹 Insurance Policy Review

• Review and interpret payer drug coverage policies (medical & pharmacy).

• Extract and organize coverage criteria, coding requirements, and rules.

 

🔹 Coverage Data Management

• Build and maintain structured databases of drug coverage information.

• Translate complex policy language into clear, actionable reference materials.

 

🔹 Prior Authorization & Billing Expertise

• Apply knowledge of prior authorization workflows and billing processes.

• Ensure alignment with payer requirements across ICD-10, CPT, and HCPCS codes.

 

🔹 Analytics & Reporting

• Monitor payer policy updates and coverage changes.

• Develop reports, trackers, and dashboards to highlight trends and variations.

 

🔹 Technology & Tools

• Use Microsoft Excel and other digital tools for data management and reporting.

• Maintain accurate and updated records in internal portals.

 

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Qualifications & Requirements

 

🎓 Education

• Bachelor of Pharmacy (BPharm) or Doctor of Pharmacy (PharmD).

 

💼 Experience

• 2–4 years of experience in US healthcare prior authorization, billing, or insurance policy review.

• Strong understanding of ICD-10, CPT, and HCPCS coding.

• Prior exposure to insurance drug coverage policies preferred.