Pharmacy Retro Term Recovery Analyst

Who We Are

Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 60 health plans, including many of the top 20, and representing more than 160 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We're constantly reimagining what's possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.

Location: This position will be hybrid, with opportunity to work full remote after training as well as in our La Grange, KY office. This position will require a 10am -7pm weekly rotation (every 6 weeks).

About the Opportunity

At Machinify, we're constantly reimagining what's possible in our industry-creating disruptively simple, powerfully clear ways to maximize our clients' financial outcomes today and drive down healthcare costs tomorrow. As part of the Pharmacy Recovery team, you will work to recover overpayments from dispensing pharmacies, healthcare providers and members. They must communicate persuasively with providers and members to facilitate payments. This communication takes place primarily through inbound and outbound calls to providers, members, and Pharmacy Benefit Managers. The Recovery Analyst will also handle other administrative duties to remain current on their accounts.

What you'll do

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  Evaluates the outstanding balances on pursuable inventory to determine the appropriate approach to maximize the recovery for our clients.

  
  
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  Contacts dispensing pharmacies, members and insurance carriers to explain why the claims were paid in error.

  
  
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  Assists with re-filing charges with appropriate party.

  
  
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  Uses discretion and judgment in dealing with providers and insurance carriers in determining when to escalate recovery issues to management and legal support.

  
  
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  Receives denials from other insurance carriers when a member has submitted a claim for payment, sends appeal letters to the other insurance carrier in timely manner and makes notes in Pharmacy systems regarding date the appeal letter was sent.

  
  
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  Maintains files according to Rawlings procedures.

  
  
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  Handles all member communications for collection or endorsement of funds with professionalism and in accordance with company standards and in compliance with FDCPA.

  
  

What experience you bring (Role Requirements)

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  Excellent oral and written communication skills are required, including a significant amount of call center or collections experience.

  
  
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  Customer service experience highly preferred.

  
  
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  Ability to work independently or in a team environment.

  
  
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  Very strong attention to detail and organizational skills.

  
  
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  Word and Excel proficiency is preferred.

  
  
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  Experience in the healthcare field is helpful, but not required.

  
  

What Success Looks Like...

After 3 months

You will have a strong understanding of the role.

You begin building relationships and collaborating with peers.

You develop effective time and priorities management.

You receive initial feedback about your performance and are using it to improve.

You've gained confidence in your abilities and are starting to feel more comfortable in your role.

After 1 year

You have mastered the tasks and responsibilities of the position, executing them with confidence and efficiency.

You have established a strong network of internal relationships and are recognized as a key collaborator.

You've been entrusted with greater responsibility indicating the company's confidence in your abilities.

You see opportunities for career progression and personal development.

Pay range: $47,000 with bonus opportunity. This is an exempt position. The salary range is for Base Salary.

What's in it for you

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  PTO, Paid Holidays, and Volunteer Days

  
  
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  Eligibility for health, vision and dental coverage, 401(k) plan participation with company match, and flexible spending accounts

  
  
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  Tuition Reimbursement

  
  
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  Eligibility for company-paid benefits including life insurance, short-term disability, and parental leave.

  
  
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  Remote and hybrid work options

  
  

At Machinify, we're reimagining a simpler way forward. This begins with our employees. We are innovators who value integrity, teamwork, accuracy, and flexibility. We do the right thing, and we listen to the needs of our clients and their members. As tenured experts with unmatched experience, we champion diverse perspectives that help us to better understand and serve our clients.

Our values come to life through our culture. We embrace flexible working arrangements that allow our employees to bring innovation to life in the way that best suits their productivity. We work cross-functionally, abandoning silos, to bring innovative, accurate solutions to market. We invest in each other through ongoing education and team celebrations, and we give back to our communities through dedicating days for volunteering. Together, Machinify is making healthcare work better for everyone, and we're passionate about a future with better outcomes for all.

We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. Machinify is an employment at will employer.

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