Recovery & Resolution Analyst - Remote

Prime Therapeutics; Home (PA); Remote; USD 85,000; Full time

Job summary

A healthcare organization based in Pennsylvania seeks a qualified candidate for a remote position involving financial analysis in Pharmacy Benefit Management. The role offers a salary up to $85,000 and includes responsibilities like claims evaluation and documentation. Candidates should have a Bachelor’s degree and relevant certification, alongside experience in a pharmacy or PBM environment.

Benefits

Opportunity for career advancement

Flexible scheduling options

Supportive and collaborative work environment

Qualifications

• Bachelor's degree in Finance, Business, or related field or equivalent education and experience.
• National Pharmacy Technician Certification through PTCB or ExCPT.
• Minimum of 2 years of work experience in a pharmacy or PBM environment.

Responsibilities

• Perform and document collection efforts such as claim adjustments.
• Evaluate audits and claims for potential recoupment.
• Identify accounts subject to collections.

Skills

Proficiency in MS Office applications

Ability to complete projects independently

Experience in claims processing

Strong analytical skills

Education

Bachelor's degree in Finance, Business, or related field

National Pharmacy Technician Certification

Tools

MS Excel

MS Word

MS PowerPoint

MS Access

Job description

Employer Industry: Pharmacy Benefit Management

Why consider this job opportunity:

• Salary up to $85,000.00 based on experience and skills
• Opportunity for career advancement and growth within the organization
• Work remotely with flexible scheduling options
• Supportive and collaborative work environment
• Chance to make a positive impact on healthcare payments and recovery processes

What to Expect (Job Responsibilities):

• Perform and document collection efforts such as claim adjustments and future payment withholding
• Evaluate audits and claims for potential recoupment, ensuring accuracy and finality
• Identify accounts subject to collections and coordinate activities with Senior Recovery and Resolution Analyst
• Prepare daily, weekly, and monthly reporting on recovery processes to support business needs
• Contribute to process improvements to enhance efficiency in the recovery and resolution team

What is Required (Qualifications):

• Bachelor's degree in Finance, Business, or related field, or equivalent education and work experience; HS diploma or GED is required
• National Pharmacy Technician Certification through PTCB or ExCPT (CPhT)
• Minimum of 2 years of work experience in a pharmacy or PBM environment, including 1 year in claims processing and 1 year in insurance, billing, or accounting
• Ability to complete projects independently and meet established timeframes
• Proficiency in MS Office applications, including Access, Excel, PowerPoint, and Word

How to Stand Out (Preferred Qualifications):

• Current Registration with the State Board of Pharmacy in the state where the position is located
• 1 year of work experience with audits in a regulated environment
• Previous experience in Pharmacy Benefit Management (PBM)