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 Title

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

Minimum Qualifications

• 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

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

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

Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail (https://www.primetherapeutics.com/benefits).

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 (including pregnancy), 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.