Analyst, Pharmacy Revenue Cycle

POSITION SUMMARY:

Under the direct supervision of the Pharmacy Revenue Cycle Manager and according to department policies, procedures, and guidelines, is responsible for providing analytical support in all areas of pharmacy-related charges and revenue. Tracks and reports various metrics as specified by department management and provides direct client support as needed. Monitors various exception-based reports designed to catch billing mistakes and resolves where appropriate. Primary contact for coordination and distribution of client payables. The Revenue Cycle Analyst-Pharmacy position requires minimal supervision and is able to work independently, with an in-depth knowledge of retail pharmacy billing and reimbursement. Creates a positive, constructive, and supportive relationship between hospital departments, Pharmacy, and Contract Pharmacy clientele. Provides training and mentoring of Pharmacy Revenue Cycle Associates.

Position: Analyst, Pharmacy Revenue Cycle       

Department: Pharmacy Revenue Cycle 

Schedule: Full Time

ESSENTIAL RESPONSIBILITIES / DUTIES:

• Collaborates with Compliance Analysts to professionally and efficiently identify client prescriptions

• Develops a process for the review and tracking of pharmacy and client prescriptions to ensure completeness and payment from insurance carriers

• Utilizes pharmacy dispensing software to re-bill claims as appropriate or as specified by management

• Prepares and maintains reports or dashboards as needed by pharmacy revenue cycle management or client

• Contacts insurance companies on applicable claim rejections/denials to seek resolution

• Routinely audits claims for accuracy and completeness. Communicates findings to appropriate parties and proposes actions for correction

• Monitors and resolves hospital drug charge edits daily

• Collaborates with Revenue Integrity, Billing and Coding, and Patient Financial Services to resolve denials as they relate to drug charges

• Performs internal price plan and price table maintenance as needed

• Identifies claims billing/payment issues and recommends actions to resolve

• Identifies and communicates quality and process improvement opportunities regarding third party billing and pharmacy revenue cycle operations

• Performs month-end reconciliation of pharmacy revenue and receipts

• Prepares and submits monthly client payables to Accounts Payable and ensures clients are paid appropriately and timely

• Performs research and special project support as needed by management

• Participates in hospital wide quality improvement activities

• Conforms to hospital standards of performance and conduct, including those pertaining to patient rights, so that the best possible customer service and patient care may be provided

• Utilizes the hospital’s cultural beliefs as the basis for decision making and to support the hospital’s mission and goals

• Follows established hospital infection control and safety procedures

• Adheres to all the principals of BMC’s RESPECT Behavioral Standards

• Responsible for the creation and maintenance of a healthy work environment. A healthy work environment is one where people feel supported, held accountable, where standards are applied and expectations are clear. A healthy work environment is one where leadership supports and leads, models behavioral standards and sets the example for how to do all things right. Critical responsibilities related to this:

• Being engaged in the department, including managing up, owning team decisions and communicating and supporting departmental and or organizational initiatives.

• Hold self and others to the highest ethical standards, and act with honor above all.

• Effective human resource management, including effectively disciplining people, recognizing people, developing and performing performance evaluations and guiding people in professional development

• Develops competencies as related to position

• Must adhere to all of BMC’s RESPECT behavioral standards

Must adhere to all of BMC’s RESPECT behavioral standards.

(The above statements in this job description are intended to depict the general nature and level of work assigned to the employee(s) in this job.  The above is not intended to represent an exhaustive list of accountable duties and responsibilities required).

JOB REQUIREMENTS

EDUCATION:

Associates Degree in Finance / Accounting or related discipline is required

Bachelor's Degree is preferred

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

Current Certified Pharmacy Technician (CPhT) License is preferred

EXPERIENCE:

• Minimum of 2 years’ experience working with and analyzing data, required

• Experience working with data to produce reports, required

• Minimum of 2-4 years’ revenue cycle or accounts receivable experience required.

• Credentialing and contracting experience highly preferred.

KNOWLEDGE AND SKILLS:

• Advanced understanding of insurance billing for various pharmacy payers
• Knowledge of Medicare/Medicaid and private payer insurance program as it related to prior authorization of medical services, eligibility, and insurance billing
• Strong research, problem-solving, and analytical skills
• Knowledge of Microsoft Office programs.
• Time management skills
• High level of independence and initiative
• Professional in conduct and demeanor
• Ability to perform multiple tasks and prioritize simultaneously
• Strong verbal and written communication

Compensation Range:

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensures as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, BMCHS offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), discretionary annual bonuses and merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family well-being. 

NOTE: This range is based on Boston-area data, and is subject to modification based on geographic location.

Equal Opportunity Employer/Disabled/Veterans

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