Travel Pharmacist - $1,497 per week in Boston, MA

Job Title: Claims Analyst Pharmacy Revenue Cycle Profession: Claims Analyst Pharmacy Revenue Cycle Specialty: Claims Analyst Pharmacy Revenue Cycle Duration: 26 weeks Shift: 8 hours Hours per Shift: 8 Experience: 1 to 3 years in healthcare, coding, finance, revenue cycle, patient accounting, and/or physician billing, preferably in a medical setting. License: Certified Pharmacy Technician (Preferred) Certifications: Coding Certification CPC, RHIT (preferred) Must-Have: Advanced working knowledge of professional billing flows, analytical and problem-solving skills, and strong interpersonal skills. Description: Revenue cycle management (RCM) is the financial process that enables healthcare organizations to fulfill their mission of providing quality care for patients and communities. Pharmacy revenue cycle is a complex process that requires a collaborative and specialized approach. Improving performance necessitates fine-tuned workflows, training, dedicated resources, collaboration across multiple departments, and routine updates to core systems. Under the direction of the Revenue Cycle Supervisor, the Revenue Cycle Claims Analyst will pursue insurance companies for payment or underpayment of services rendered through extensive telephone and written correspondence. The analyst will also substantiate accurate reimbursement through correct contract terms, billing practices, and compliance with state and federal guidelines. The ability to analyze, audit, problem-solve, and reconcile accounts is critical to this position. Duties include researching, resolving, and preparing claims that have not passed payer edits daily. The analyst will determine and initiate actions to resolve rejected drug claims. This role requires serving as a subject matter expert for strategic relationships, service issues, reimbursement, and claims. Possessing excellent medical and billing terminology skills is essential, as is the ability to read, analyze, and interpret prescription drug orders. Monitoring rejections on all electronic and paper claims will help determine where enhancements or fixes are needed in system edits to gain efficiencies and prevent ongoing rejections. Knowledge of Medicare and third-party codes and billing procedures, as well as patient billing techniques, is necessary. Effective communication of issues and results will occur through multiple media, including in-person meetings, workgroups, verbal communication, email, and presentations. Understanding regulatory billing codes and practices is important to assess billing accuracy before submission for processing and payment. Collaboration with team members and other revenue cycle departments will contribute to improving denials and avoidable write-offs. Analytical skills will be applied to pre-established work processes that may require preparing reports or documents for further review or analysis. The analyst will research, analyze, and respond to inquiries regarding compliance, payer policies, and guidelines, inappropriate coding, denials, and billable services. Follow-up on outstanding account balances will occur in accordance with organizational protocol, emphasizing client satisfaction and provider profitability. Utilizing the organization’s core values as the basis for decision-making will facilitate the overall mission.