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Drug Claim (Pharmacy) Analyst

Company: The Rawlings Group
Location: La Grange
Posted on: March 19, 2023

Job Description:

The Drug Claim Payment Integrity Retro Term Recovery Analyst is responsible for maximizing the recovery of pharmacy claim overpayments. The Analyst evaluates outstanding balances on pursuable inventory to determine the appropriate approach to generate recoveries for our clients. The Analyst will make outreach to dispensing pharmacies, members, and insurance carriers to explain the reason why the claims were paid in error, assist with refiling charges with the appropriate party, and sending appeal letters for any denied claims to insurance carriers in a timely manner. The Analyst will also handle all member communications for collection or endorsement of funds with professionalism and in accordance with Company standards and federal regulations such as FDCPA.
Hours: Day shift, 40-hour work weeks. During training, 8am - 5pm.
Setting: Professional office environment (with remote opportunity available after six months of employment based on performance).
Compensation: This is an exempt position at a very competitive salary, $47,000 with significant bonus opportunity. Top 20% of our Analysts earned $85,000+ last year. Our comprehensive benefit package includes health and dental benefits, short-term disability plans, 401k with company matching, paid time off policy and more. We also offer an onsite gym, cafe, and coffee shop.
Training: The Rawlings Company takes great pride in providing exemplary training and development program, including policies and procedures, state-of-the-art proprietary systems, and many other tools to place new employees on the path to success.

  • Evaluates outstanding balances on pursuable inventory.
    • Contacts dispensing pharmacies, members and insurance carriers explaining errors on paid claims.
    • Assists with re-filing charges with appropriate party.
    • Uses discretion and judgment in dealing with providers and insurance carriers in determining when to escalate recovery issues to management and legal support.
    • Processes remits and disbursements in a timely manner.
    • Receives denials and sends appeals to and from insurance carriers when a member has submitted a claim for payment.
    • Maintains files according to Rawlings procedures.
    • Handles all member communications for collection or endorsement of funds with professionalism and in accordance with company standards and in compliance with FDCPA.
    • Able to work at our facility from 10am - 7pm
      • Associate Degree, Bachelors Preferred or equivalent combination of experience in health insurance or related fields.
      • Call center or business to business collections experience preferred.
      • Proficient in Microsoft Word, Excel, and Outlook.
      • Very strong written and verbal communication skills.
      • Very strong attention to detail and organizational skills.
      • Ability to identify and resolve tense situations.
      • Ability to work well in a team environment.
        Physical Requirements
        • Frequently remains in sitting position for long periods of time to perform duties.
        • Frequently concentrates for long periods of time, paying close attention to detail.
        • Frequently uses and views the computer using fingers, hands, and vision.
        • Frequently works in a well-lit, tempered environment.
        • Occasionally moves through office to communicate with other employees
          Our Company Culture
          The Rawlings Group is looking for hard-working, talented people who share our commitment to excellence to join our company. The Rawlings Company has successfully provided cost containment services to the largest health insurers in the country for more than 40 years and continues to grow as an industry leader.
          Our Culture is focused on:
          • The guiding principle of doing the right thing
          • Caring for our employees and taking pride in the work they do
          • Providing recognition and financially rewarding employees for their success
            Our Values are:
            • Integrity and Trust
            • Customer Service Excellence
            • Innovation
            • Diversity and Inclusion
            • Honoring our Veterans and Their Service

              • Equal Employment Opportunity. It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification.
              • The Rawlings Group is an employment at will employer.

Keywords: The Rawlings Group, Louisville , Drug Claim (Pharmacy) Analyst, Healthcare , La Grange, Kentucky

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