The Rodenhizer Group is a business process outsourcing firm that pharmaceutical companies rely on to manage all or part of their drug rebate departmental functions. Our mission is to be a complete solutions partner for our clients.
We have over two decades of experience!
Our founder, Craig Rodenhizer was introduced to claims processing while working at The Travelers Insurance Company in 1991.
“One day I got a fateful call to help their struggling claims audit and overpayment recovery unit. Once I got a taste, I was hooked.”
After developing a proven process to scrub claims data for The Travelers, it was time to offer the service to the world. Craig left The Travelers, partnered with three good friends and colleagues, and hit the pavement.
We soon met Ron Rogers, Director of Pharmacy Programs for the Minnesota Department of Human Services. Ron is a Medicaid Drug Rebate Program expert with a wealth of information. The next several months were dedicated to developing a process that would help Medicaid agencies detect and correct errors in the prescription claims data and resolve disputed rebates.
The Kentucky Department for Medicaid Services agreed to be our first client. Kentucky had $35 million in disputed rebates from 1991 through 1996. After a series of validation testing and pharmacy audits, the prescription-level claim errors were corrected and we found $28 million of the disputes were justified, and the remaining $7 million were collected.
While inspecting Kentucky’s rebate history it became clear that many drug manufacturers were being overcharged and paying too much in Medicaid rebates. Equipped with this knowledge, we decided to begin overpayment recovery for manufacturers. We quickly discovered this work was a good fit and full of new and exciting opportunities.
While completing overpayment recovery for many large clients we gained a better understanding of why errors within the Medicaid rebate process occur and how to prevent them. We witnessed firsthand the struggles our clients encountered as their government pricing department was flooded with quarterly invoices of varying media types. It was at this point we decided to automate the process of recording invoices and normalize the data for faster, more accurate payments.
As we gained the confidence of our clients we gained more responsibilities. Processing quarterly invoices evolved into producing monthly and quarterly reports. Soon after we were calculating pricing and producing rebate projections.
Working closely with our clients allows us to identify potential for improvement. From everyday nuisances to large scale problems, our goal is to develop solutions for all of our clients’ needs.