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Maintain existing relationships with national payers and drive business specification for the implementation of new systems to support implementation of new electronic billing standards with national payers. Demonstrate initiative in identifying process improvements that increase the effectiveness of the division’s recovery efforts to significantly increase pharmacy recoveries Develop effect
Posted 1 day ago
Lead the development of business requirements to implement new initiatives, requiring complex data analysis applied to pharmacy and medical data, to achieve program objectives and create value for health insurance and pharmacy benefit manager clients. Transform data analysis of health insurance and pharmacy benefit claims data into new ideas to generate cost containment and financial recoveries fo
Posted 1 day ago
Analyzes the receivables and effectively recovers outstanding balances to increase the recovery rate while reducing the days outstanding. Contacts dispensing pharmacies, members and insurance carriers and explains coordination of benefits on existing files in order to obtain refunds for our clients. Assists with re filing charges with appropriate party. Uses discretion and judgment in dealing wit
Posted 1 day ago
The Rawlings group, founded in 1977, is the premiere leader in payment integrity services to the health insurance industry. As a member of the Data Science Team, you will have 30 years of health care data at your fingertips to identify complex problems, review related information, research alternatives and develop solutions to unique problems. You will use past information to predict future perfo
Posted 1 day ago
Under the supervision of the Manager of Data Mining, the Data Analyst learns the needs of the business community and is responsible for the analysis and reporting of production data mining results. ESSENTIAL DUTIES & RESPONSIBILITIES Develops and maintains SQL queries to solve critical business problems. Creates Tableau dashboards to effectively communicate findings. Responsible for proper
Posted 1 day ago
All candidates must be able to interview on site. We do not offer webcast or Facetime interviews. POSITION SUMMARY Support business units by performing all quality control testing to ensure no adverse impact on customers, financials, operations or systems. This position may include quality assurance testing for business application and support for other Business Units as required. Candidate must h
Posted 1 day ago
The Auditor is responsible for closing the required number of audits per day based upon the audit type with a 100% quality score. The Auditor investigates claims data to identify overpaid/incorrectly paid claims and initiates the recovery of that money for our clients. The position requires extensive online research in clients’ claims systems, internal research materials, internet resources
Posted 1 day ago
The Auditor is responsible for closing the required number of audits per day based upon the audit type with a 100% quality score. The Auditor investigates claims data to identify overpaid/incorrectly paid claims and initiates the recovery of that money for our clients. The position requires extensive online research in clients’ claims systems, internal research materials, internet resources
Posted 1 day ago
This position will be responsible for ensuring that mail and files will be processes in a timely manner. The ideal candidate should have general clerical competence and be energetic, enthusiastic, and eager to learn new skills. ESSENTIAL DUTIES AND RESPONSIBILITIES Operate scanner, postage machine, copy machine, OPEX, and Scandall software. Open and process checks. Prep documents to be imaged. Ima
Posted 2 days ago
Audits bulk liens at both the individual lien and claim level Reviews liens based on relatedness of medical claims details Requests and organizes incoming language for No Subro state LRP requests Handles non LRP lists of plaintiffs submitted by administrators/law firms Performs reviews of claims to determine if any claim lines are duplicated OTHER DUTIES & RESPONSIBILITIES Consistently meets
Posted 2 days ago
Do you have a knack for building applications that directly impact an organization? Are you a wizard with C#, .Net and Angular JS then The Rawlings Group is looking for you!!! All applications are proprietary and are used in house only. Candidates should be uniquely skilled and have the ability to think outside the box. We are looking for Software Developers who are passionate about joining a comp
Posted 4 days ago
Identify, qualify, and open files for the Workers Comp and Subrogation departments by, researching correspondence with insufficient information using multiple systems and making outbound calls as necessary to get the correct information. Review insurance claim data from client systems and validate the accuracy of the liens we are building. ESSENTIAL DUTIES & RESPONSIBILITIES Access client sy
Posted 4 days ago
The Pharmacy Support Specialist is responsible for performing various client on line look ups and validation procedures which support the production and distribution of client audits in the Pharmacy Division. The role involves organizing, storing and processing both digital and paper information. The Pharmacy Support Specialist must be comfortable using digital hardware and software, so they can t
Posted 4 days ago
If you're looking for a career and not just a job.....
Posted 8 days ago
If you're looking for a career and not just a job.....
Posted 9 days ago
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