Claims Analyst, Pharmacy Revenue Cycle

Job not on LinkedIn

🔥 12 minutes ago

🍂 Massachusetts – Remote

🍂 Massachusetts – Remote

💵 $56k - $78.5k / year

⏰ Full Time

🟢 Junior

📋 Claims Specialist

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Boston Medical Center (BMC)

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1996

Boston Medical Center (BMC) is a 511-bed, equity-led academic medical center and a proud member of the Boston Medical Center Health System. BMC delivers a model of healthcare where innovative and equitable care empowers all patients to thrive. As a premier academic medical center in Boston, a national leader in clinical care, and the largest essential hospital in New England, BMC’s world-class clinicians provide comprehensive care in more than 70 specialties and subspecialties.

📋 Description

• Research, resolve, and prepare claims that have not passed payer edits daily • Determine and initiate action to resolve rejected drug claims • Serve as subject matter expert for provider relationships, service issues, reimbursement, and claims • Monitor electronic and paper claim rejections and identify system-edit enhancements or fixes • Assess billing accuracy before submission for processing and payment • Collaborate with revenue cycle teams to improve denials and avoidable write-offs • Research, analyze, and respond to inquiries about compliance, payer policies, coding, denials, and billable services • Follow up on outstanding account balances at 45 days from the date of service • Monitor and resolve Claims Work queues, including Front End, Referrals & Authorizations, and Clinical Workflow • Convert pharmacy drug quantities into Medicare billing units before submitting CMS-1500 claims • Ensure billable services are processed in EPIC in a timely manner • Analyze information from multiple sources and synthesize actionable information • Educate and provide feedback on Pharmacy Revenue Cycle rejection metrics and key performance indicators

🎯 Requirements

• Bachelor’s degree in Business, Healthcare, or closely related field, or equivalent work experience • 1 to 3 years of experience in healthcare, coding, finance, revenue cycle, patient accounting, and/or physician billing • Certified Pharmacy Technician preferred • CPC or RHIT coding certification preferred • Advanced working knowledge of professional billing flows, charge entry, editing-system functionality, and revenue cycle tasks • Ability to analyze and solve complex system-process and workflow problems • Strong knowledge of NCCI and MUE claim edits • Ability to convert pharmacy drug quantities into Medicare billing units according to Medicare guidelines • EPIC proficiency for processing billable services • Working knowledge of CPT/HCPCS and ICD-10-CM-PCS diagnosis codes and professional coder workflows • Knowledge of hospital and professional billing, collection, and reimbursement requirements • Working knowledge of drug NDC numbers and unit conversion • Knowledge of contracts, fee schedules, and edits for complex denials and payment variances • Strong analytical, interpersonal, organizational, written, oral, and presentation skills • Must complete a background check before employment • Must be vaccinated against COVID-19 and flu and receive a COVID-19 booster dose

🏖️ Benefits

• Medical, dental, vision, and pharmacy benefits • Discretionary annual bonuses • Merit increases • Flexible Spending Accounts • 403(b) savings matches • Paid time off • Career advancement opportunities • Resources to support employee and family well-being • COVID-19 and flu vaccination coverage/requirement