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Pharmacy Retro Term Analyst - 10:00AM - 7:00PM

Description

Post Term Recovery Analyst
The Pharmacy Post-Term Recovery Analyst is responsible for maximizing recovery of pharmacy claim overpayments by working with dispensing pharmacies, members and commercial insurance carriers. The Pharmacy Post-Term Recovery Analyst is responsible for maximizing recovery of pharmacy claim overpayments by working with dispensing pharmacies, members and commercial insurance carriers. 



ESSENTIAL DUTIES & RESPONSIBILITIES

  • Analyzes the receivables and effectively recovers outstanding balances to increase the recovery rate while reducing the days outstanding. 

  • Contacts dispensing pharmacies, members and insurance carriers and explains coordination of benefits on existing files in order to obtain refunds for our clients.

  • Assists with re-filing charges with appropriate party.

  • Uses discretion and judgment in dealing with providers and insurance carriers in determining when to escalate recovery issues to management and legal support.

  • Receives appeals from healthcare providers and insurance carriers, sends an acknowledgement of receipt in a timely manner and makes notes in Pharmacy systems regarding date acknowledgement letter was sent. 

  • Makes determinations on appeals and sends determination letters in a timely manner.

  • Makes notes in Pharmacy systems regarding all activity on existing files.

  • Maintains files according to Rawlings procedures.

  • Processes remits and disbursements.

  • Handle all member communications for collection or endorsement of funds with professionalism and in accordance with company standards and in compliance with FDCPA.

  • Bring any violations or potential violations of HIPAA to the attention of the Team Manager immediately.



 

SKILLS & ABILITIES

Required Skills and Abilities
  • Excellent written and verbal Spanish language skills coupled with good English language skills

  • Strong analytical skills

  • Must have advanced skills in Microsoft Excel

  • Excellent phone communication skills.

  • Ability to work well in a team environment.

  • Very strong attention to detail and organizational skills.

  • Pharmacy benefit management experience is very beneficial.

  • Ability to identify and resolve tense situations.

  • Persistence and diplomacy required.

  • Must maintain confidential information. 

Requirements

EDUCATION & EXPERIENCE REQUIREMENTS

  • Minimum of an Associates degree highly preferred.

  • Call center or business to business collections experience preferred.

  • Experience in pharmacy related field preferred

Job Snapshot

Location US-KY-LaGrange, KY
Employment Type Full-Time
Pay Type Year
Pay Rate N/A
Store Type Health Care, Pharmaceutical, Insurance
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Company Overview

Rawlings Group

The Rawlings Group was formed in 1977 to offer legal services to insurance providers. Recognizing the need for specialized recovery services, Rawlings launched what would ultimately become the first subrogation outsourcing program for the healthcare industry. We subsequently launched other outsourcing programs specifically dedicated to medical claims recovery, mass tort litigation, and pharmaceutical claims recovery. Learn More

Contact Information

US-KY-LaGrange, KY
Snapshot
Rawlings Group
Company:
US-KY-LaGrange, KY
Location:
Full-Time
Employment Type:
Year
Pay Type:
N/A
Pay Rate:
Health Care, Pharmaceutical, Insurance
Store Type:

Description

Post Term Recovery Analyst
The Pharmacy Post-Term Recovery Analyst is responsible for maximizing recovery of pharmacy claim overpayments by working with dispensing pharmacies, members and commercial insurance carriers. The Pharmacy Post-Term Recovery Analyst is responsible for maximizing recovery of pharmacy claim overpayments by working with dispensing pharmacies, members and commercial insurance carriers. 



ESSENTIAL DUTIES & RESPONSIBILITIES

  • Analyzes the receivables and effectively recovers outstanding balances to increase the recovery rate while reducing the days outstanding. 

  • Contacts dispensing pharmacies, members and insurance carriers and explains coordination of benefits on existing files in order to obtain refunds for our clients.

  • Assists with re-filing charges with appropriate party.

  • Uses discretion and judgment in dealing with providers and insurance carriers in determining when to escalate recovery issues to management and legal support.

  • Receives appeals from healthcare providers and insurance carriers, sends an acknowledgement of receipt in a timely manner and makes notes in Pharmacy systems regarding date acknowledgement letter was sent. 

  • Makes determinations on appeals and sends determination letters in a timely manner.

  • Makes notes in Pharmacy systems regarding all activity on existing files.

  • Maintains files according to Rawlings procedures.

  • Processes remits and disbursements.

  • Handle all member communications for collection or endorsement of funds with professionalism and in accordance with company standards and in compliance with FDCPA.

  • Bring any violations or potential violations of HIPAA to the attention of the Team Manager immediately.



 

SKILLS & ABILITIES

Required Skills and Abilities
  • Excellent written and verbal Spanish language skills coupled with good English language skills

  • Strong analytical skills

  • Must have advanced skills in Microsoft Excel

  • Excellent phone communication skills.

  • Ability to work well in a team environment.

  • Very strong attention to detail and organizational skills.

  • Pharmacy benefit management experience is very beneficial.

  • Ability to identify and resolve tense situations.

  • Persistence and diplomacy required.

  • Must maintain confidential information. 

Requirements

EDUCATION & EXPERIENCE REQUIREMENTS

  • Minimum of an Associates degree highly preferred.

  • Call center or business to business collections experience preferred.

  • Experience in pharmacy related field preferred

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Pharmacy Retro Term Analyst - 10:00AM - 7:00PM Apply now