[Hiring] Claims Analyst Pharmacy Revenue Cycle @BMC Software

Role Description

Revenue cycle management (RCM) is the financial process that makes it possible for healthcare organizations to fulfill their mission of providing quality care for patients and communities. Pharmacy revenue cycle is a complex process and requires a collaborative and specialized approach. Improving performance requires:

• Fine-tuned workflows
• Training
• Dedicated resources
• Collaboration across multiple departments
• Routine updates to core systems

Under the direction of the Revenue Cycle Supervisor Pharmacy, the Revenue Cycle Claims Analyst is responsible for pursuing insurance companies for payment or underpayment of services rendered through extensive telephone and written correspondence. Responsibilities include:

• Substantiating accurate reimbursement through correct contract terms, billing practices, and compliance with state and federal guidelines.
• Analyzing, auditing, problem-solving, and reconciling accounts.
• Conducting duties in accordance with industry federal and state billing guidelines and contractual obligations.

As part of the Pharmacy Complex Claims team, we bring traditional revenue cycle functions into the department of pharmacy, providing significant opportunities for our health system.

Qualifications

• Bachelor’s degree in Business, Healthcare, or closely related field or equivalent work experience.
• Certified Pharmacy Technician (Preferred)
• Coding Certification CPC, RHIT (preferred)

Requirements

• 1 to 3 years of experience in healthcare, coding, finance, revenue cycle, patient accounting, and/or physician billing, preferably in a Medical Center setting, Oncology or Home/Office Infusion settings.
• Advanced working knowledge of professional billing flows including charge entry, editing system functionality, and revenue cycle tasks.
• Ability to analyze and solve complex problems related to system processes and workflows.
• Responsible for monitoring and resolving Claims Work queues; specifically, Front End, Referrals & Authorizations, and Clinical Workflow.
• Strong knowledge of claim edits NCCI (National Correct Coding Initiative Edits) and MUE (Mutually Unlikely Edits).
• Ability to convert pharmacy drug quantities into Medicare billing units according to Medicare Guidelines prior to submitting medical CMS1500 claim forms.
• Ensures all billable services are processed in EPIC in a timely manner.
• Superior analytical skills to critically evaluate information gathered from multiple sources and synthesize it into actionable information.
• Strong interpersonal skills to elicit cooperation from a wide variety of sources, including upper management, clients, and other departments.
• Strong interpersonal skills with attention to detail and ability to organize, interpret, and present data.
• Must be able to present information effectively in both written and oral forms, tailoring messages to the audience.
• Understanding and knowledge of the business, products, programs, corporate organizational structure, and basic research principles/methodologies.
• Working knowledge of CPT/HCPCS and ICD-10-CM-PCS diagnosis codes.
• Knowledge of hospital and professional billing, collection, and reimbursement requirements and standard practice.
• Working knowledge of drug NDC numbers and unit conversion.
• SME (Subject Matter Expert) for complex denials and payment variances including contracts, fee schedules, and edits.
• Educates and provides feedback to various areas on Pharmacy Revenue Cycle rejection metrics and key performance indicators.

Benefits

• Compensation Range: $56,000.00 - $78,500.00
• Generous total compensation including benefits (medical, dental, vision, pharmacy).
• Discretionary annual bonuses and merit increases.
• Flexible Spending Accounts.
• 403(b) savings matches.
• Paid time off.
• Career advancement opportunities.
• Resources to support employee and family well-being.

Company Description

Equal Opportunity Employer/Disabled/Veterans

According to the FTC, there has been a rise in employment offer scams. Our current job openings are listed on our website and applications are received only through our website. We do not ask or require downloads of any applications, or “apps” job offers are not extended over text messages or social media platforms. We do not ask individuals to purchase equipment for or prior to employment.