Representative, Payer Conversions

This role is office-based in Mexico. The role requires professional fluency in English (spoken and written).

Under the minimal supervision of the PRCM Operations Supervisor or PRCM Operations Manager and through collaboration with fellow team members, the Conversion Representative facilitates resolving Unapplied Cash Category 1 (UAC Cat 1) through the conversion of paper remittance advice to electronic remittance advice, setting up secure transmission connections with carriers, and establishing working relationships with Pharmacy Benefit Managers and insurance carriers.

Major Responsibilities/Essential Functions: 

Facilitate the conversion from paper remittance advice to electronic remittance advice. Electronic remittance conversion is key as it reduces manual efforts of managing paper remittance. (70%) 

• Analyze client/carrier trends to identify conversion opportunities

• Create and maintain conversion tracking logs for all assigned clients

• Participates in Onboarding meetings with clients

• Responsible for weekly/monthly updates to the Conversion team metrics

Professionally communicate with Pharmacy Benefit Managers and Insurance Carriers to retrieve electronic remittance advices (15%):

• Establish a working relationship with the client’s Pharmacy Benefit Managers and Insurance Carriers.

• Understand the communications channels within the assigned Pharmacy Benefit Manager and Insurance Carriers

• Must be able to track requests for the conversion to electronic remittances. 

• Consistently follow-up on electronic conversion requests with carriers

Collaborate with other teams key functional teams as necessary (10%):

• Proactively communicate any known issues to team members

• Escalate items as needed to manager for higher level distribution

• Prioritize conversion requests to meet the demands of a diverse client base

• Communicates with Client Service and Client Operations teams regarding conversion updates

• Communicates with EDI/NOC/SFTP centralization team for electronic communication setups and password resets

Perform special projects and other duties as assigned by management (5%)

Follow HIPAA policies and procedures per company guidelines

Minimum Requirements:

• Bachelor’s degree (B.A.) from four-year college or university with a major in business administration, accounting, finance, or related field OR four or more years of related work experience and/or training; OR equivalent combination of training and experience

• Intermediate-level proficiency using MS Excel and Google Workspace

• Ability to work in fast paced, high capacity work environment

• Ability to proceed independently and carry out assignments to completion with minimal instruction.

• Ability to create documents requiring accuracy and confidential handling 

• Ability to maintain detailed, accurate records and files

• Ability to organize tasks and time to ensure timely completion of all projects

• Ability to use good judgment in recognizing scope of authority

• Ability to facilitate communications and problem solve

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