The Rawlings group, founded in 1977, is the premier leader in payment integrity services to the health insurance industry. Located in La Grange, KY, The Rawlings Group employs over 1,400 people and is growing. If you are looking for a great opportunity to make positive impact on the future of healthcare, The Rawlings Group needs to be your career choice.
If you are a motivated professional with progressive experience and proven ability to lead a large-scale, high volume healthcare receivables function, improving financial performance and quality, our Pharmacy Division wants to hear from you.
We are seeking a Manager of Recovery Operations for the Pharmacy Division. This is a new position due to growth. This position is responsible for driving increased recovery performance across various methods utilized for recovery of pharmacy claim overpayment receivables for our health plan clients. This includes managing internal recovery processes through a specialized recovery team interacting with all national payers. The position is also responsible for developing external stakeholder relationships involved with recovery processes, and continuing efforts to further develop and implement industry practices for recovery of overpayments from pharmacy benefit managers, other health plans and employer group payers.
- Three to five years’ progressive experience and proven ability to enhance the quality, productivity and performance of a large healthcare receivables management function.
- Experience in the pharmacy benefit management or health insurance industries a significant plus.
- Proficiency in Microsoft Office with advanced skills in Excel with large data sets.
- Experience using PIVOT Tables and V-Lookup preferred.
- Experience using SQL or demonstrated aptitude to learn data management and analysis tools
ESSENTIAL DUTIES & RESPONSIBILITIES
- Maintain existing relationships with national payers and drive business specification for the implementation of new systems to support implementation of new electronic billing standards with national payers.
- Demonstrate initiative in identifying process improvements that increase the effectiveness of the division’s recovery efforts to significantly increase pharmacy recoveries
- Develop effective recovery approaches, processes and procedures for aggregating recovery opportunities by payer, as well as handling individual recovery cases with employer groups.
- Effectively educate payers on requirements for reimbursement of overpayments associated with coordination of benefits, including Medicare Secondary Payer requirements, as well as Hospice and ESRD drug exclusions under Medicare Part D.
- Lead a team of recovery analysts specialized in recovery of pharmacy claim overpayments. .Develop best practices and manage team goals and objectives to achieve growth targets and developing expertise of team members.
- Provide timely and accurate reporting and analysis of key recovery performance metrics and trends to management.
- Escalate recovery issues to management and legal support as needed to overcome specific payer or broader industry
SKILLS & ABILITIES
- Demonstrated leadership abilities, including achieving team goals, objectives and priorities, including the ongoing monitoring and development of staff.
- Ability to apply critical thinking to identify and implement recommendations to overcome issues and obstacles impairing recovery effectiveness.
- Strong analytical skills with experience organizing and summarizing data and preparing analysis and recommendations.
- Strong verbal and written communication skills, with experience to persuade, motivate and inspire.
- Maintain professional behavior at all times with industry stakeholders, peers and direct reports.