Job Description
Job Description
Overview
The Revenue Cycle Associate is responsible for working with third party pharmacy payers to secure payment on electronically approved or manually billed claims
This is a remote position. Applicants can live any where within the continental USA.
Schedule: Monday - Friday, 8:00am -4:30pm
We Offer
• Medical, Dental & Vision Benefits plus, HSA & FSA Savings Accounts
• Supplemental Coverage – Accident, Critical Illness and Hospital Indemnity Insurance
• 401(k) Retirement Plan
• Company paid Life and AD&D Insurance, Short-Term and Long-Term Disability
• Employee Discounts
• Tuition Reimbursement
• Paid Time Off & Holidays
Our Pharmacy group focuses on providing exceptional customer service and meeting the pharmacy needs for hospitals, rehabilitation hospitals, long-term acute care hospitals, and other specialized care centers nationwide. If your passion is service excellence and top-quality care come join our team and apply today!
Responsibilities
• Work with third party pharmacy payers, including Medicare Part D, Medicaid, Commercial Insurance, Worker’s Comp, Auto Insurance, and Hospice, to secure payment on electronically approved or manually billed claims
• Work with internal and external customers to resolve assigned portfolio of accounts in a timely manner by collecting the balance due or by taking other action, as appropriate
• Communicate with payers via the telephone, email or on-line websites to gain claim status information, obtain payment details or obtain documentation to identify claims that may have been recouped due to audit.
• Work with internal departments, such as Contracting, Audit, and 3rd Party Plan Administration, to obtain necessary information in order to bill or reconcile open AR.
• Work with multiple internal databases and reporting tools (Cloud docs, Cognos, Access, etc.) to research and locate payment, check, or remit information
• Report to management any issues that may result in uncollected revenue, including payers that are non-responsive or claims that are not successfully resolved after multiple attempts
• Researches unapplied cash and resolves misdirected payments.
• Print and key variances or write-off’s for review by Team Lead and management to clear uncollectable revenue per guidelines of Sarbanes Oxley requirements and Signature Compliance guidelines.
• May be responsible for rebilling claims either electronically in accordance with NCPDP standards, online through payer specific websites, or manually through Universal Claim Forms or other approved methods for favorable resolution of denied claims or underpayments
• Maintain and accurately report all reconciliation activity on monthly aging spreadsheets
• Record daily productivity results accurately in the Productivity Database
• Properly document all communication and follow up that is necessary to collect reimbursement
• Works through assignments independently and timely with limited direction
• Able to handle high volume and significant workload
• Work with 3rd Party Claims Reconciliation Supervisor and/or Manager on special projects as needed
• Performs other related duties as assigned
• Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards
Qualifications
Education/Learning Experience
• Required: High School graduate, GED or equivalent experience
• Desired: Associates degree, 4 year college or technical degree
Work Experience
• Required: 1 year insurance claims reconciliation, Accounts Receivable and/or collections experience
• Desired: Third Party Billing or collections/billing experience in the healthcare industry
• Desired: AS-400 computer experience, typing skills and Excel Spreadsheet experience
• Desired: General understanding of billing requirements for Medicare Part D, Medicaid, and Commercial billing
• Desired: Understanding of revenue cycle functions within pharmacy practice or equivalent setting
Skills/Knowledge
• Required: Proficiency in MS Office Products (Excel, Word) and basic computer knowledge
• Required: Excellent time management skills and attention to detail
• Required: Comfortable making phone calls and interacting with internal/external entities
• Desired: AS400 Computer Systems Experience