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.