CommUnityCare Health Centers
Revenue Cycle Specialist - Pharmacy Buy and Bill
CommUnityCare Health Centers, Austin, Texas, us, 78716
Revenue Cycle Specialist - Pharmacy Buy and Bill
Join to apply for the
Revenue Cycle Specialist - Pharmacy Buy and Bill
role at
CommUnityCare Health Centers Revenue Cycle Specialist - Pharmacy Buy and Bill
2 days ago Be among the first 25 applicants Join to apply for the
Revenue Cycle Specialist - Pharmacy Buy and Bill
role at
CommUnityCare Health Centers The Pharmacy Buy and Bill AR Specialist is responsible for managing the accounts receivable (AR) processes related to buy-and-bill medications. This includes verifying insurance coverage, submitting claims, resolving billing discrepancies, and ensuring timely reimbursement from payers. The role requires collaboration with pharmacy teams, healthcare providers, and insurance companies to streamline the revenue cycle and minimize denials.
Essential Functions
Claims Management
Submit accurate claims for buy-and-bill medications to insurance payers. Track claims to ensure timely processing and reimbursement. Identify and address claim rejections and denials promptly.
Accounts Receivable Monitoring
Reconcile payments and outstanding balances for buy-and-bill medications. Maintain detailed records of payer communications and payment status. Follow up on unpaid or underpaid claims.
Insurance Verification
Confirm insurance eligibility and coverage for buy-and-bill medications. Collaborate with pharmacy and clinical teams to obtain prior authorizations when required. Compliance and Documentation Ensure claims comply with payer policies, coding standards, and regulations. Maintain organized and accurate documentation for audit purposes.
Process Improvement
Identify opportunities to optimize the buy-and-bill billing process. Implement solutions to enhance efficiency and reduce denials.
Knowledge, Skills and Abilities
Advanced knowledge of medical terminology, ICD 10, CPT, HCPCS coding and HIPAA requirements. Ability to communicate effectively, both orally and in writing Demonstrated proficiency in the use of computer and commonly used software, including electronic medical records (EMR). Extensive knowledge and experience with commercial, government and state billing and reimbursement procedures. Proficiency in insurance verification, prior authorization, and AR follow-up. Attention to detail, organizational skills, customer service orientation, and analytical thinking. Through leadership and by example, ensures that services are provided in accordance with state and federal regulations,organizational policy, and accreditation/compliance requirements. Promptly identify issues and reports them to their direct supervisor. Maintain regular and predictable attendance. Acts in accordance with CommUnityCare’s mission and values, while serving as a role model for ethical behavior.
Minimum Education
High School Diploma or equivalent (higher degree accepted)
Minimum Experience
2 years medical billing, pharmacy billing, or revenue cycle management, particularly in buy-and-bill processes.
Seniority level
Seniority level Entry level Employment type
Employment type Full-time Job function
Job function Accounting/Auditing and Finance Industries Hospitals and Health Care Referrals increase your chances of interviewing at CommUnityCare Health Centers by 2x Get notified about new Revenue Specialist jobs in
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Join to apply for the
Revenue Cycle Specialist - Pharmacy Buy and Bill
role at
CommUnityCare Health Centers Revenue Cycle Specialist - Pharmacy Buy and Bill
2 days ago Be among the first 25 applicants Join to apply for the
Revenue Cycle Specialist - Pharmacy Buy and Bill
role at
CommUnityCare Health Centers The Pharmacy Buy and Bill AR Specialist is responsible for managing the accounts receivable (AR) processes related to buy-and-bill medications. This includes verifying insurance coverage, submitting claims, resolving billing discrepancies, and ensuring timely reimbursement from payers. The role requires collaboration with pharmacy teams, healthcare providers, and insurance companies to streamline the revenue cycle and minimize denials.
Essential Functions
Claims Management
Submit accurate claims for buy-and-bill medications to insurance payers. Track claims to ensure timely processing and reimbursement. Identify and address claim rejections and denials promptly.
Accounts Receivable Monitoring
Reconcile payments and outstanding balances for buy-and-bill medications. Maintain detailed records of payer communications and payment status. Follow up on unpaid or underpaid claims.
Insurance Verification
Confirm insurance eligibility and coverage for buy-and-bill medications. Collaborate with pharmacy and clinical teams to obtain prior authorizations when required. Compliance and Documentation Ensure claims comply with payer policies, coding standards, and regulations. Maintain organized and accurate documentation for audit purposes.
Process Improvement
Identify opportunities to optimize the buy-and-bill billing process. Implement solutions to enhance efficiency and reduce denials.
Knowledge, Skills and Abilities
Advanced knowledge of medical terminology, ICD 10, CPT, HCPCS coding and HIPAA requirements. Ability to communicate effectively, both orally and in writing Demonstrated proficiency in the use of computer and commonly used software, including electronic medical records (EMR). Extensive knowledge and experience with commercial, government and state billing and reimbursement procedures. Proficiency in insurance verification, prior authorization, and AR follow-up. Attention to detail, organizational skills, customer service orientation, and analytical thinking. Through leadership and by example, ensures that services are provided in accordance with state and federal regulations,organizational policy, and accreditation/compliance requirements. Promptly identify issues and reports them to their direct supervisor. Maintain regular and predictable attendance. Acts in accordance with CommUnityCare’s mission and values, while serving as a role model for ethical behavior.
Minimum Education
High School Diploma or equivalent (higher degree accepted)
Minimum Experience
2 years medical billing, pharmacy billing, or revenue cycle management, particularly in buy-and-bill processes.
Seniority level
Seniority level Entry level Employment type
Employment type Full-time Job function
Job function Accounting/Auditing and Finance Industries Hospitals and Health Care Referrals increase your chances of interviewing at CommUnityCare Health Centers by 2x Get notified about new Revenue Specialist jobs in
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We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr