Pharmacy Revenue Cycle Analyst

Vaga não está no LinkedIn

🕒 Maio 15

🐎 Kentucky – Remoto

🐎 Kentucky – Remote

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

🧐 Analista

Candidatar-se

Encontrar Vagas Remotas Similares

Receber Emails de Vagas Remotas

📊 Verifique sua pontuação de currículo para esta vaga

Melhore suas chances de conseguir uma entrevista verificando sua pontuação de currículo antes de se candidatar.

Enviar Currículo

Baptist Health System KY & IN

SiteLinkedInTodas as Vagas

10.000+ funcionários

Fundada em 1924

⚕️ Seguro de Saúde

Healthcare Insurance

O Baptist Health System KY & IN é um provedor de saúde abrangente operando em Kentucky e no sul de Indiana. Oferece uma ampla gama de serviços, como saúde comportamental, cuidados oncológicos, gastroenterologia, cuidados cardíacos, imagem e diagnósticos, e cuidados especializados para mãe e bebê, neurologia, AVC, ortopedia e medicina esportiva. O sistema proporciona vários tipos de cuidado, incluindo atendimento de emergência, de urgência e virtual, e apoia a saúde digital por meio do aplicativo MyChart. O Baptist Health está comprometido com a saúde da comunidade por meio de programas de extensão, educação e pesquisa, e enfatiza a segurança do paciente e cuidados de qualidade em suas numerosas localizações. Oferece amplas oportunidades de carreira na área da saúde e se esforça por transparência e cuidado centrado no paciente.

Descrição

• The Pharmacy Revenue Cycle Analyst is responsible for ensuring optimal revenue capture for pharmacy services provided at Baptist Health to help maximize financial performance. • Monitor revenue cycle performance by reviewing pharmacy charge capture, correctly capturing and coding pharmacy charges, ensuring accuracy of inpatient and outpatient claims processing and reviewing denials and write-off assessments. • Utilize expertise in coding to ensure efficiency and excellence for patients and providers. • Assist pharmacy leadership in developing and maintaining the payment models for managed care negotiations, payment auditing, and denial management. • Analyze, update, and correct claims data to ensure billing for all inpatient, outpatient commercial, Medicare, Medicaid, MCOs, and community pharmacy PBM accounts is accurate and timely. • Collaborate with accounts receivable through prompt and accurate billing, payment auditing, credits, and follow up of all patient accounts with Medicare, Medicare Advantage, Medicaid, PBMs, and MCOs. • Coordinate with sites, managed care, and the business office to decrease medication-related claim denials, underpayments, and outstanding claims. • Review, investigate, and process high dollar and high dispense quantity work queue items. • Perform quality reviews to ensure that pharmacy charge description master (PCDM) additions, inactivations, changes and/or revisions were accurately completed in the clinical and financial systems. • Assist Baptist Health’s pharmacy contract negotiating team in developing and maintaining up to date, accurate payment models for contract management processes and reporting on current profitability, payor analysis and other key areas of analysis. • Collaborate with clinical staff, other departments, and physician offices to request assistance when necessary to successfully appeal an account. • Ensure appropriate follow ups on accounts until a resolution is reached or all reasonable appeal options are exhausted. • Assist with contract compliance and identify savings opportunities. • Test and implement software upgrades related to payment modeling software with IT and software vendor. • Develop quality metrics and audit methodologies to drive accuracy and first-time quality for all HCPCS/CPT codes, revenue codes, billable units, multipliers, modifiers, and indications. • Assist with the development and enhancement of analytical tools for prospective and retrospective audits and data analysis. • Coordinate the overall maintenance of all pharmacy revenue cycle scorecards, dashboards and key performance indicators. • Audit price file updates from wholesaler, non-wholesaler, Epic, charges, and patient information. • Develop reports to highlight the proposed vs. actual financial impact by contract term. • Provide education to site and system stakeholders to drive optimal revenue capture and compliance. • Assist with development of policies, guidelines, and procedures for pharmaceutical coding, billing, pricing, charging, and denial management. • Participate in committees, work groups, process improvement efforts, and educational initiatives.

🎯 Requisitos

• Bachelor's degree, and 3 years minimum job-related experience. • 4 years additional experience may be substituted for a degree. • Strong knowledge of general ledger accounts and coding. • Accounting, Finance, or equivalent college level courses in accounting (preferred). • Home Care Specialist-Diagnosis (HCS-D) (preferred). • Home Care Specialist – Oasis (HCS-O) or Certificate for OASIS Specialist – Clinical (COS-C) (preferred). • Hospital and Community based experience with expertise in billing and compliance (preferred). • Experience in CDM maintenance (preferred). • Direct experience in healthcare (preferred).

🏖️ Benefícios

• Baptist Health is an Equal Employment Opportunity employer • Drug-free workplace