PI and DCPI Operations Support Manager

Job Details

Job Summary

This position is responsible for leading and managing the Payment Integrity (PI) and Drug Claim Payment Integrity (DCPI) Support teams.

This position will also be responsible for new client implementations for Payment Integrity and setting up internal configurations.

Hours : Day shift, 40-hour work weeks. During training, 8am - 5pm. Flexible schedule options available between 7am - 7pm following training.

Setting : Professional office environment (Remote Flexibility)

Compensation : This is a non-exempt position at a very competitive salary. Our comprehensive benefit package includes health and dental benefits, short-term disability plans, 401k with company matching, paid time off policy and more.

We also offer an onsite gym, cafe, and coffee shop.

Training : The Rawlings Company takes great pride in providing exemplary training and development program, including policies and procedures, state-of-the-art proprietary systems, and many other tools to place new employees on the path to success.

Responsibilities

• Leads and manages PI and DCPI Support teams.
• Maintains knowledge of ACT, Smart, Rxtra, RxSelect and PIVOT systems (internal systems).
• Implements and maintains ACT, Smart and PIVOT configurations. Assists in testing and rollout of new PIVOT system.
• Assists Director of Distribution and Product Support in establishing proper configurations for new clients in SMART, ACT and PIVOT and complete testing.
• Maintains and implements scrubbing exceptions for data integrity to support Operations.
• Backup for updating letter templates as requested by business and clients.
• The ability to work at our Facility and maintain a regular work schedule of Monday through Friday.

Qualifications

• Bachelor’s Degree or equivalent combination of education and experience in health insurance or related fields, which would provide the necessary knowledge, skills, and abilities to successfully perform the work.
• Proficient in Microsoft Office, specifically Excel and Word.
• SQL knowledge preferred.
• Management experience preferred.
• Knowledge of ACT, Smart, Rxtra and RxSelect Systems preferred (internal applicant only).
• Strong analytical skills.
• Excellent verbal and written communication skills.
• Demonstrates organizational skills with proven attention to detail.
• Demonstrates integrity and honesty in all aspects of job performance.
• Professional in dealing with Audit management, Analysts, Client Success, Finance and any other individual with whom this position interacts.
• Possess time management skills, able to prioritize work and perform multiple tasks at a time.

Physical Requirements

• Frequently remains in sitting position for long periods of time to perform duties.
• Frequently concentrates for long periods of time, paying close attention to detail.
• Frequently uses and views the computer using fingers, hands, and vision.
• Frequently works in a well-lit, tempered environment.
• Occasionally moves through office to communicate with other employees.

Our Company Culture

The Rawlings Group is looking for hard-working, talented people who share our commitment to excellence to join our company.

The Rawlings Companyhas successfully provided cost containment services to the largest health insurers in the country for more than 40 years and continues to grow as an industry leader.

Our Culture is focused on :

• The guiding principle of doing the right thing.
• Caring for our employees and taking pride in the work they do.
• Providing recognition and financially rewarding employees for their success

Our Values are :

• Integrity and Trust
• Customer Service Excellence
• Innovation
• Diversity and Inclusion
• Honoring our Veterans and Their Service
• Equal Employment Opportunity. It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification.
• The Rawlings Group is an employment at will employer.

INDHP