Recovery & Resolution Analyst

🔥 5 minutes ago

🇺🇸 United States – Remote

💵 $53k - $85k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🧐 Analyst

🦅 H1B Visa Sponsor

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Prime Therapeutics

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1998

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

Prime Therapeutics is a trusted pharmacy solutions provider dedicated to transforming health care through innovation and transparency. The company offers a wide range of services including clinical solutions for improved member outcomes, drug access and affordability, specialty drug management, and condition management for chronic health issues. With over 7,000 employees, Prime Therapeutics aims to challenge norms in the pharmacy industry, providing exceptional experiences and simplifying the complex for millions across the nation. Their mission goes beyond profit, focusing on creating transformative impacts with long-term solutions, utilizing modern technology and holistic approaches in specialty pharmacy management. Owned by mission-driven partners, Prime Therapeutics emphasizes true transparency and conflict-free service, fostering a culture of care and shared purpose in health care.

📋 Description

• Recover inappropriate pharmacy payments related to billing errors and fraud, waste and abuse through claim adjustments, future payment withholding, and coordination with external collection agencies • Ensure payment recoveries are accurately processed in Prime’s systems for audit and investigation recoupments • Perform and document collection efforts • Evaluate audits, investigations, and claims for potential recoupment and verify results • Recommend recoupment or adjustment actions • Identify accounts subject to collections and coordinate with the Senior Recovery and Resolution Analyst on third-party collection activities • Review checks submitted to the lock box daily and reject checks associated with already-collected audits, investigations, or claims • Prepare daily, weekly, and monthly recovery-process reporting • Identify and contribute to process improvements • Perform other duties as assigned

🎯 Requirements

• Bachelor's degree in Finance, Business, or related area, or equivalent combination of education and/or related work experience • High school diploma or GED 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 • Experience must include 1 year in claims processing in an operations, audit, or quality assurance environment • Experience must include 1 year in insurance, billing, collections, or accounting • Must be eligible to work in the United States without work visa or residency sponsorship • Ability to complete projects independently within established timeframes • Problem-solving and troubleshooting ability • Proficiency with MS Office, including Access, Excel, PowerPoint, and Word • Intermediate understanding of point-of-sale and online pharmacy claims processing • Excellent oral, written, and interpersonal communication skills • Organization and analytical skills • Ability to manage multiple tasks and projects simultaneously • Ability to communicate effectively with varied audiences at all organizational levels • Ability to maintain confidentiality of highly sensitive information • Current registration with the State Board of Pharmacy in the state where the position is located preferred • 1 year of audit experience in a regulated environment preferred • Previous PBM experience preferred • Must comply with job-specific security responsibilities, legal, regulatory, contractual, and internal policy requirements • Must be able to perform the essential functions of the job, with reasonable accommodations available when appropriate

🏖️ Benefits

• Potential pay ranging from $53,000.00–$85,000.00 based on experience and skills • Benefits, incentives and additional compensation are available through Prime’s Benefits Page • Equal opportunity and affirmative action employer • Reasonable accommodations for qualified applicants with disabilities • Tobacco-Free Workplace