Key skills
AnalyticsLeadershipSales
About this role
Role Overview
- Oversee initial claims file submissions and conduct comprehensive QA summaries to identify potential fallouts before submission.
- Manage rejections from external partners; perform root-cause analysis on data issues and re-submit corrected claims to maximize capture.
- Monitor and "push" for the billing of claims missed during initial windows due to vendor delays or data gaps, ensuring no revenue is left on the table.
- Build and maintain master rate lists based on current formularies and utilization management (UM) to correspond with product-specific rates.
- Marry billed amounts back to rate lists to identify missing, incorrect, or inappropriately billed amounts.
- Verify incoming payments against invoiced amounts; identify and dispute short-payments or missing funds.
- Build out rebate performance reports.
- Run monthly "pro-forma" estimates of expected rebates to serve as a benchmark for actual collections.
- Manage and optimize the internal dashboards to provide "slice-and-dice" visibility into rebate trends for executive leadership and sales teams.
Requirements
- Bachelor’s Degree: Finance, Accounting, Data Analytics, Economics, or Business Administration.
- Minimum of 2 years of direct experience with a GPO or similar rebate aggregators/aggregating platforms is highly preferred.
- Proficiency in managing large data sets at the NDC-11 level. Advanced Excel is required.
- Strong understanding of the "reconciliation loop" connecting initial claims to invoices, and invoices to actual cash received
- A proven ability to track "Stale Billing" and "Post-Billing Rejects" through to resolution.
- Proven knowledge of pharmacy benefit management practices, including UM and clinical program design.
Benefits
- Highly competitive wellness benefits including Medical, Pharmacy, Dental, Vision, and Life Insurance and AD&D Insurance
- Flexible Spending Benefits
- 401(k) Retirement Savings Program
- Short-term and long-term disability
- Discretionary Paid Time Off
- Paid Company Holidays
- Wellness Benefits
- Commuter Benefits
- Paid Parental Leave benefits
- Employee Assistance Program (EAP)
- Well-stocked kitchen in office locations
- Professional development and training opportunities