Pharmacy Revenue Cycle Specialist - Westwood, MA
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POST DATE 8/21/2020
END DATE 9/20/2020
Beth Israel Deaconess Medical Center
JOB DESCRIPTIONDEPARTMENT DESCRIPTION: Supporting new Westwood Pharmacy opening Fall 2020!
JOB LOCATION: Westwood, MA
REQ ID: 35482BR
JOB SUMMARY: The Revenue Cycle Specialist is charged with coordinating the billing, analysis and effective resolution of claims within the BIDMC Pharmacy Corporation. The analyst will be responsible for timely billing, claims auditing and resolutions with the goal to reduce overall denials and increase revenue. This includes interpreting payment and denial data down to the line item detail, identifying payer and coding trends, risks, and opportunities, and implementing operational or systematic improvements. Essential to this position are strong quantitative, analytical and organizational skills. Excellent communication and interpersonal skills with the ability to effectively interpret, communicate, and educate others.
* Develops a process for the review and tracking of pharmacy and client prescriptions to ensure completeness and payment from insurance carriers.
* Evaluates unresolved third party claims, e.g. rejects and denials. Designs and maintains matrix to monitor the results of the department to achieve specific financial goals of the institution.
* Utilizes pharmacy software to re-bill claims as appropriate or as specified by management.
* Routinely audits claims for accuracy and completeness. Communicates findings to appropriate parties and proposes actions for correction.
* Contacts insurance companies on applicable claim rejections/denials to seek resolution.
* Prepares and maintains reports or dashboards as needed by pharmacy management or clients.
* Identifies and proposes resolutions for systems issues or changes that impede timely and accurate billing of services and timely payment for those services. Works with programming areas to specify necessary code changes in multiple systems, test and approve code changes for implementation in production and to confirm efficacy of changes in production.
* Bachelor's degree in Finance, Accounting, or a Health related field required.
* 1-3 years related work experience required.
* Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web-based applications. May produce complex documents, perform analysis and maintain databases.
* Prior revenue cycle or claims processing experience, highly preferred.
* 340B program knowledge strongly preferred. Retail/Outpatient Pharmacy experience, highly preferred.
* Knowledge of ICD-10 and CPT coding. Cash handling and/or bookkeeping experience.
* Decision Making: Ability to make decisions that are guided by general instructions and practices requiring some interpretation. May make recommendations for solving problems of moderate complexity and importance.
* Problem Solving: Ability to address problems that are varied, requiring analysis or interpretation of the situation using direct observation, knowledge and skills based on general precedents.
* Independence of Action: Ability to follow precedents and procedures. May set priorities and organize work within general guidelines. Seeks assistance when confronted with difficult and/or unpredictable situations. Work progress is monitored by supervisor/manager.
* WRITTEN COMMUNICATIONS: Ability to summarize and communicate in English moderately complex information in varied written formats to internal and external customers.
* ORAL COMMUNICATIONS: Ability to comprehend and communicate complex verbal information in English to medical center staff, patients, families and external customers.
* KNOWLEDGE: Ability to demonstrate full working knowledge of standard concepts, practices, procedures and policies with the ability to use them in varied situations.
* TEAM WORK: Ability to act as a team leader for small projects or work groups, creating a collaborative and respectful team environment and improving workflows. Results may impact the operations of one or more departments.
* CUSTOMER SERVICE: Ability to provide a high level of customer service and staff training to meet customer service standards and expectations for the assigned unit(s). Resolves service issues in the assigned unit(s) in a timely and respectful manner.
PHYSICAL NATURE OF THE JOB:
Sedentary work: Exerting up to 10 pounds of force occasionally in carrying, lifting, pushing, pulling objects. Sitting most of the time, with walking and standing required only occasionally
Equal Opportunity Employer
Beth Israel Deaconess Medical Center is an Equal Opportunity Employer. We comply with the laws and regulations set forth by the U.S. Department of Labor.