Recovery & Resolution Analyst - Remote
At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.Job Posting TitleRecovery & Resolution Analyst - RemoteJob DescriptionThe 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.ResponsibilitiesPerform and document collection efforts such as claim adjustments, future payment withholding and/or coordination with an external collection agencyEvaluate 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 appropriateIdentify accounts that are subject to collections; coordinate with Senior Recovery and Resolution Analyst to support driving collections activities conducted by a third partyReview 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 collectedPrepare daily, weekly and monthly reporting on recovery processes to support pharmacy, client or internal business needs and communicationsIdentify and contribute to process improvements to drive efficiency and innovation in recovery and resolution teamOther duties as assignedMinimum QualificationsBachelor'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 requiredNational 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 accountingMust be eligible to work in the United States without need for work visa or residency sponsorshipAdditional QualificationsAbility to complete projects independently and within established timeframesAbility to effectively problem solve and troubleshoot issuesProficiency within MS Office such as Access, Excel, PowerPoint, and WordIntermediate skill and understanding of the point of sale and on-line pharmacy claims processing environmentExcellent oral, written and interpersonal communication skillsSelf-directed worker with excellent organization and analytical skill...