Sr. Associate Analyst, Pharmacy Collections

About the role

The Sr. Associate Analyst, Pharmacy Collections is responsible for managing a high-volume portfolio of pharmacy adjudicated claims, including payer follow-up, denial research and resolution, underpayment review, credit balance management, and ensuring cash collections of such activities. This role works assigned accounts to secure timely and accurate reimbursement, reduce aging, resolve claim issues, and ensure compliance with payer, regulatory, and departmental productivity standards.

Responsibilities

• Manage a high-volume portfolio of pharmacy adjudicated claims and perform timely follow-up on outstanding accounts to maximize cash collections and reduce aged receivables.
• Research and resolve denials, underpayments, rejections, and payment variances by reviewing claim history, EOBs, remittance advice, payer guidelines, and supporting documentation.
• Analyze account balances and reimbursement activity to identify root causes, escalate trends, and recommend corrective actions that improve collection performance and claim resolution.
• Cook up with payers, PBMs, internal billing teams, and cross-functional partners to resolve claim issues, support resubmissions, ensure adherence to timely filing and reimbursement requirements and maximize cash collections.
• Manage credit balances, refund requests, and overpayment activity in accordance with contractual, regulatory, and legal requirements, including Medicare and Medicaid guidelines.
• Serve as a subject matter resource for collection workflows, respond to process-related questions, and assist with first-level issue escalation and account resolution support.
• Prepare clear account summaries, trend analysis, and recommendations for leadership to support issue resolution, process improvements, and operational decision-making.
• Support implementation of new processes, pilots, and workflow enhancements, including knowledge transfer and training to team members as needed.
• Maintain accurate documentation of collection activity, claim status, and account disposition.

Requirements

• 2+ years of high-volume pharmacy and/or medical accounts receivable, billing, and collections experience; senior-level or lead experience preferred.
• Demonstrated experience working pharmacy adjudicated claims, interpreting EOBs and remittance advice, and performing detailed research on denials, underpayments, and outstanding balances.
• Strong knowledge of payer guidelines, reimbursement practices, timely filing requirements, and credit balance or refund processes.
• Ability to identify root causes, analyze trends, and resolve complex account issues independently with minimal supervision.
• Highly organized, proactive, and able to manage multiple priorities in a fast-paced, high-volume environment.
• Strong analytical, problem-solving, and communication skills with the ability to collaborate effectively across teams and with external payers.
• Results-driven mindset focused on AR resolution, reimbursement accuracy, and continuous process improvement.
• Knowledge of general accounting principles and proficiency in Microsoft Office Suite, including Outlook, Excel, Word, PowerPoint, Teams, and SharePoint.