Claims Analyst Pharmacy Revenue Cycle

POSITION SUMMARY : Revenue cycle management (RCM) is the financial process that makes it possible for healthcare organization to fulfil their mission of providing quality care for patients and communities. Pharmacy revenue cycle is complex process and requires a collaborative and specialized approach. Improving performance requires fine-tuned workflows, training, dedicated resources, collaboration across multiple departments, and routine updates to core systems. 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 BMC. Position : Claims Analyst Pharmacy Revenue Cycle Department : Pharmacy Revenue Cycle Schedule: Full Time ESSENTIAL RESPONSIBILITIES / DUTIES: 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