Job Information
Prime Therapeutics Recovery & Resolution Analyst in Montgomery, Alabama
Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.
Job Posting Title
Recovery & Resolution Analyst
Job Description
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.
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
Education & Experience
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
Must be eligible to work in the United States without the need for work visa or residency sponsorship.
Additional Qualifications
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
Preferred Qualifications
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
Physical Demands
Frequently required to sit, use hands to handle or feel, talk and hear
Frequently required to stand, use hands to handle or feel, talk and hear
Frequently required to reach with hands and arms
Occasionally required to stand, walk and stoop, kneel, and crouch
Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds
Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Potential pay for this position ranges from $53,000.00 - $85,000.00 based on experience and skills.
To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page (https://www.primetherapeutics.com/benefits) and click on the "Benefits at a glance" button for more detail.
_Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (pregnancy, sexual orientation, and gender identity), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law. _
We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.
Prime Therapeutics LLC is a Tobacco-Free Workplace employer.
Positions will be posted for a minimum of five consecutive workdays.
Prime Therapeutics' fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.
If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people's lives.
Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (pregnancy, sexual orientation, and gender identity), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.
We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.
Prime Therapeutics LLC is a Tobacco-Free Workplace employer.
If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.866.469.1257 or email Careers@primetherapeutics.com.