Pharmacy Audit Creation & Production Specialist
The Rawlings Group 2.37 reviews - La Grange, KY

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The Rawlings Group was formed in 1977 to offer legal services to insurance providers. Recognizing the need for specialized recovery services, Rawlings launched what would ultimately become the first subrogation outsourcing program for the healthcare industry. We subsequently launched other outsourcing programs specifically dedicated to medical claims recovery, mass tort litigation, and pharmaceutical claims recovery.

As market demand for our recovery services continued to grow, our organizational focus became more defined. Today, The Rawlings Group is focused exclusively on recovery services for our health insurance company clients. Due in part to this focus and in part to our tenacious commitment to servicing the needs of our clients, we are the largest and most successful company in this segment of the market.

Under the supervision of the Director of Audit Creation and Production, the Pharmacy Audit Creation and Production Specialist is responsible for the oversight and management of existing mining logic and the development and refinement of new mining logic and delivery systems. Additionally, this position will lead and assist on special projects with a focus on continual process and system improvement.

ESSENTIAL FUNCTIONS:

Evaluate existing data and mining logic and lead the cross functional effort with the business and IT to integrate pharmacy data into our production structure.
Develops and maintains SQL queries to deliver, track, and report query and audit results.
Responsible for the proper communication regarding all aspects of the mining logic and results as well as the coordination of any training or follow-up necessary.
Using written and verbal feedback, performs detailed level analysis to improve mining results.
Works with various teams to design and create decision support and process maps related to mining results.
Assists in the investigation and reporting of query and review results.
Performs other duties as assigned.

MINIMUM REQUIREMENTS:

Bachelor's degree in business, accounting, IT or a related field desired.
Five to seven years related experience, preferably in an insurance setting.
Proficient in the use of Access, SQL, and Excel. Visio is a plus.
Understanding of database structures and relational databases.
Ability to perform process and decision mapping.
Strong interpersonal, analytical and communication skills.
Proactive, inquisitive and creative in approach to work.
Ability to handle multiple projects effectively.

BEHAVIORAL SKILLS: Demonstrates professionalism in all dealings with peers and management.

PHYSICAL AND MENTAL REQUIREMENTS: Ability to sit for long periods of time. Ability to operate a computer keyboard. Correctable hearing and vision required. Capacity to identify, assimilate and analyze complex information and communication recommendations needed.

WORK ENVIRONMENT: Office environment with minimal noise level.

About this company
2.37 reviews
Since 1985, The Rawlings Group has pioneered every major innovation in our industry. We are: Pioneers in developing the first outsourced...