Recovery & Resolution Analyst - Remote

Prime Therapeutics•Home, WV

2d•$53,000 - $85,000•Remote

About The Position

The Recovery & Resolution Analyst is responsible for recovering inappropriate pharmacy payments related billing errors and fraud, waste and abuse (FWA) through various mechanisms, including but not limited to: claim adjustments, future payment withholding and coordination with an external collection agency. This position ensures payment recoveries are accurately processed in Prime's systems for recoupment of audits and investigations performed by the Pharmacy Audit Operations and Special Investigations Unit (SIU) teams.

Requirements

Bachelor's degree in Finance, Business or related area of study or equivalent combination of education and/or related work experience; HS diploma or GED is required
National Pharmacy Technician Certification through PTCB or ExCPT (CPhT)
2 years of work experience in retail, long term care, specialty, home infusion, or mail order pharmacy or combined pharmacy and PBM experience to include: 1 year of work experience in claims processing in an operations, audit or quality assurance environment
1 year of work experience in insurance, billing, collections or accounting
Must be eligible to work in the United States without need for work visa or residency sponsorship
Ability to complete projects independently and within established timeframes
Ability to effectively problem solve and troubleshoot issues
Proficiency within MS Office such as Access, Excel, PowerPoint, and Word
Intermediate skill and understanding of the point of sale and on-line pharmacy claims processing environment
Excellent oral, written and interpersonal communication skills
Self-directed worker with excellent organization and analytical skills
Ability to work on multiple tasks and project simultaneously
Ability to work and communicate effectively with a variety of audiences at all levels of the organization
Ability to maintain confidentiality of highly sensitive information

Nice To Haves

Current Registration with the State Board of Pharmacy in the state where position is located
1 year of work experience with audit in a regulated environment
Previous PBM experience

Responsibilities

Perform and document collection efforts such as claim adjustments, future payment withholding and/or coordination with an external collection agency
Evaluate audits, investigations and/or claims identified for potential recoupment to verify that results are final and accurate; make recommendations on recoupment or adjustment actions as appropriate
Identify accounts that are subject to collections; coordinate with Senior Recovery and Resolution Analyst to support driving collections activities conducted by a third party
Review checks submitted to lock box daily to verify they are related to audits or investigations; reject checks received on audits, investigations, or claims that have already been collected
Prepare daily, weekly and monthly reporting on recovery processes to support pharmacy, client or internal business needs and communications
Identify and contribute to process improvements to drive efficiency and innovation in recovery and resolution team
Other duties as assigned