Claims Analyst, Pharmacy Revenue Cycle

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🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $56k - $78.5k / year

⏰ Full Time

🟢 Junior

📋 Claims Specialist

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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 strategic 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 departments to improve denials and avoidable write-offs • Prepare reports or documents for further review or analysis • Research, analyze, and respond to inquiries regarding 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 • Ensure all billable services are processed in EPIC in a timely manner • Educate and provide feedback on Pharmacy Revenue Cycle rejection metrics and key performance indicators • Pursue insurance companies for payment or underpayment through telephone and written correspondence • Substantiate accurate reimbursement through contract terms, billing practices, and regulatory compliance

🎯 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 • Coding Certification CPC, RHIT preferred • Advanced working knowledge of professional billing flows, including charge entry, editing system functionality, and revenue cycle tasks • Ability to analyze and solve complex problems related to system processes and workflows • Experience monitoring and resolving Claims Work queues, specifically Front End, Referrals & Authorizations, and Clinical Workflow • Strong knowledge of NCCI and MUE edits • Ability to convert pharmacy drug quantities into Medicare billing units according to Medicare guidelines • Knowledge of EPIC • 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 and standard practices • Working knowledge of drug NDC numbers and unit conversion • Knowledge of Medicare and third-party codes, billing procedures, regulatory guidelines, and industry standards • Strong analytical, interpersonal, organizational, written, and oral presentation skills • Ability to read, analyze, and interpret prescription drug orders

🏖️ 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

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