Provides financial analysis support and insight to pharmacy rebates from manufacturers.
Provides control, coordination, reconciliation and management of financial data flow for strategic planning, variance analysis, management reporting, budgeting, forecasting, and support of ad-hoc analysis to meet operational requirements.
Analyzes monthly budget and revenue results to identify key growth drivers and trends.
Leads the monthly management forecast process for pharmacy rebate manufacturers.
Recommends and implements system solutions for the budget and forecast processes.
Presents budget and forecast analysis and presentations for senior management.
Responsible for claims reconciliations and claims processing.
Identify and manage payment data related to claims, rebill, and manage overrides.
Audit readiness and fraud detection—including clawbacks, reversals, and EFT traceability
Responsible for cycle close out reconciliation and month end bank reconciliation.
Daily banking overview, validating and posting receipts.
Liaison with pharmacies, PBMs, and health plans to resolve payment discrepancies.
Educate providers on billing processes and assistance programs.
Supports and maintains an ongoing process of system and procedure reevaluation.
Monitors and reports on areas of operational risk and/or opportunity. May guide support data analysts and commercial owners in reconciliation. Research and report on ad hoc information requests.
Requirements
Bachelor's Degree Or equivalent in Finance/Accounting Required.
5+ years of progressively responsible experience in business analysis, accounting and finance required.
Healthcare Industry experience Required.
Experience with pharmacy billing software, MS Excel, and EHR systems preferred.
Experience with third-party claims adjudication and reconciliation tools such as Opus, and Central Pay preferred.
Technical & Regulatory Knowledge including understanding of PBM systems and Medicaid/Medicare billing, familiarity with NCPDP standards, and knowledge of HIPAA compliance and PCI standards for handling sensitive patient and payment data.
Experience with reconciliation dashboards and data dictionaries.
Excellent time management skills and ability to work independently or with a team.
Proven record of results working with senior management.
Strong project management skills and the ability to translate business issues into financial requirements.
Benefits
Health insurance
Flexible work arrangements
Professional development opportunities
Applicant Tracking System Keywords
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