Thinksoft Technologies LLC
Claims Analyst Pharmacy Revenue Cycle
Thinksoft Technologies LLC, Boston, Massachusetts, us, 02298
Benefits
Competitive salary Health insurance Training & development Overview
Position Title: Claims Analyst Pharmacy Revenue Cycle. Position Type: Remote. Duration: 6 months. Shift: 8 hours Days Shift. Compensation Details: Gross Hourly Pay Rate: $41/hr. Job Description: Under the direction of the Revenue Cycle Supervisor Pharmacy, the Revenue Cycle Claims Analyst is responsible through extensive telephone and written correspondence, will pursue insurance companies for payment or underpayment of services rendered. Will also substantiate accurate reimbursement through correct contract terms, billing practices and compliance with state and federal guidelines. Must have the ability to analyze, audit, problem solve and reconcile an account is critical to this position. Conducts duties in accordance with industry federal and state billing guidelines and contractual obligations and in compliance with department policies and procedures. As part of the Pharmacy Complex Claims team, we are able to bring traditional revenue cycle functions into the department of pharmacy which can provides significant opportunities for our health system. Key factors are hiring individuals with financial, pharmacy and medical revenue cycle expertise as a reimbursement solutions that identify and recover overlooked revenue for the Hospital. Responsibilities
Research, resolve, and prepare claims that have not passed the payer edits daily. Determine and initiate action to resolve rejected drug claims. Serve as subject matter expert for strategic provider relationships, service issues, reimbursement and claims. Possess excellent medical and billing terminology skills; Ability to read, analyze and interpret prescription drug orders. Monitor rejections on all electronic and paper claims to determine where enhancements or fixes are needed in system edits to gain efficiencies and to prevent ongoing rejections. Knowledge of Medicare and third-party codes and billing procedures as well as patient billing techniques. Effectively communicate issues and results via multiple media including in-person meetings, workgroups, verbal communication, email and presentations. Knowledge of Medicare and other regulatory billing codes and practices in order to assess billing for accuracy prior to submission to appropriate agency or company for processing and payment. Should be well-versed in regulatory guidelines and industry standards for Medicare and/or specific payer benefit providers. Collaborates with team and other revenue cycle departments to improve denials, avoidable write-offs. Applies analytical skills to pre-established work processes that may require preparation of reports or documents for further review or analysis. Research, analyze, and respond to inquiries regarding compliance, payor policies and guidelines, inappropriate coding, denials, and billable services. Follow-up on outstanding account balances at 45-days from the date of service in accordance to organizational protocol with an emphasis on maximizing client satisfaction and provider profitability. Utilize Hospital's Core Values as the basis for decision making and to facilitate hospital mission. Qualifications
Education: Bachelor’s degree in Business, Healthcare or closely related field or equivalent work experience. Certificates, Licenses, Registrations Required: Certified Pharmacy Technician (Preferred); Coding Certification CPC, RHIT (preferred). Experience: 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. Knowledge and Skills: Requires advanced working knowledge of professional billing flows including charge entry, editing system functionality, and revenue cycle tasks. Strong knowledge of claim edits NCCI Edits and MUE. Ability to convert pharmacy drug quantities into Medicare billing units. EPIC billing processing in a timely manner. Working knowledge of CPT/HCPCS and ICD-10-CM-PCS diagnoses codes and hospital and professional billing, collection and reimbursement requirements. Working knowledge of drug NDC numbers and unit conversion. SME 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 KPIs. Other: Must have a working knowledge of hospital operations, regulatory guidelines, and payer policies as they relate to pharmacy revenue cycle. This is a remote position.
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Competitive salary Health insurance Training & development Overview
Position Title: Claims Analyst Pharmacy Revenue Cycle. Position Type: Remote. Duration: 6 months. Shift: 8 hours Days Shift. Compensation Details: Gross Hourly Pay Rate: $41/hr. Job Description: Under the direction of the Revenue Cycle Supervisor Pharmacy, the Revenue Cycle Claims Analyst is responsible through extensive telephone and written correspondence, will pursue insurance companies for payment or underpayment of services rendered. Will also substantiate accurate reimbursement through correct contract terms, billing practices and compliance with state and federal guidelines. Must have the ability to analyze, audit, problem solve and reconcile an account is critical to this position. Conducts duties in accordance with industry federal and state billing guidelines and contractual obligations and in compliance with department policies and procedures. As part of the Pharmacy Complex Claims team, we are able to bring traditional revenue cycle functions into the department of pharmacy which can provides significant opportunities for our health system. Key factors are hiring individuals with financial, pharmacy and medical revenue cycle expertise as a reimbursement solutions that identify and recover overlooked revenue for the Hospital. Responsibilities
Research, resolve, and prepare claims that have not passed the payer edits daily. Determine and initiate action to resolve rejected drug claims. Serve as subject matter expert for strategic provider relationships, service issues, reimbursement and claims. Possess excellent medical and billing terminology skills; Ability to read, analyze and interpret prescription drug orders. Monitor rejections on all electronic and paper claims to determine where enhancements or fixes are needed in system edits to gain efficiencies and to prevent ongoing rejections. Knowledge of Medicare and third-party codes and billing procedures as well as patient billing techniques. Effectively communicate issues and results via multiple media including in-person meetings, workgroups, verbal communication, email and presentations. Knowledge of Medicare and other regulatory billing codes and practices in order to assess billing for accuracy prior to submission to appropriate agency or company for processing and payment. Should be well-versed in regulatory guidelines and industry standards for Medicare and/or specific payer benefit providers. Collaborates with team and other revenue cycle departments to improve denials, avoidable write-offs. Applies analytical skills to pre-established work processes that may require preparation of reports or documents for further review or analysis. Research, analyze, and respond to inquiries regarding compliance, payor policies and guidelines, inappropriate coding, denials, and billable services. Follow-up on outstanding account balances at 45-days from the date of service in accordance to organizational protocol with an emphasis on maximizing client satisfaction and provider profitability. Utilize Hospital's Core Values as the basis for decision making and to facilitate hospital mission. Qualifications
Education: Bachelor’s degree in Business, Healthcare or closely related field or equivalent work experience. Certificates, Licenses, Registrations Required: Certified Pharmacy Technician (Preferred); Coding Certification CPC, RHIT (preferred). Experience: 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. Knowledge and Skills: Requires advanced working knowledge of professional billing flows including charge entry, editing system functionality, and revenue cycle tasks. Strong knowledge of claim edits NCCI Edits and MUE. Ability to convert pharmacy drug quantities into Medicare billing units. EPIC billing processing in a timely manner. Working knowledge of CPT/HCPCS and ICD-10-CM-PCS diagnoses codes and hospital and professional billing, collection and reimbursement requirements. Working knowledge of drug NDC numbers and unit conversion. SME 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 KPIs. Other: Must have a working knowledge of hospital operations, regulatory guidelines, and payer policies as they relate to pharmacy revenue cycle. This is a remote position.
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