The posting
Additional Considerations (if any):
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At Amber Specialty Pharmacy, our commitment to patient care is unmatched. Enjoy fulfillment in a career where you have the opportunity to make a positive impact on patients with complex and chronic conditions.
- Monday-Friday (no weekends)
- Hours: 8:00 a.m. - 5:00 p.m. CST
- Wages: Hourly $20.00-$22.00
- No weekends
- Six paid holidays
- Must pass post-offer, pre-employment drug background tests as allowed by state, federal, local ordinance, statutes and licensing/accreditation requirements.
Job Title: Revenue Integrity Analyst
Department: Operations -Revenue Integrity
Work Location: In-office position
FLSA: Non-Exempt
General Function:
The Revenue Integrity Analyst will perform functions to ensure all necessary information is entered into the patient account to maximize reimbursement of all claims billed by the Company. This includes obtaining accurate insurance information using multiple methods and entering it in the correct payer sequence. The Revenue Integrity Analyst also gathers the necessary information to bill electronic NCPDP claims, reviews statements to determine accuracy, assists patients and caregivers with navigating financial assistance programs when needed, ensures the accurate correction of claims processing, whether electronic pharmacy claims or medical claims, and ensures that confirmation of delivery tickets is handled timely and appropriately. It is the goal of the Revenue Integrity Analyst to make corrections and identify where there is the potential for increased efficiencies, all while communicating with coordinators, payers, and co-workers using exceptional customer service and professionalism, all while ensuring the integrity of all revenue streams.
Reporting Relations:
Reports to: Lead Revenue Integrity Analyst
Direct Reports: N/A
Primary Responsibilities:
- This position is an office-based position
- Working knowledge of all necessary computer software to perform job duties
- Contacts the patient, when necessary; to gather insurance and billing information or notify of a delay in processing
- Contacts the patient and/or payer to resolve all types of payer and/or coverage issues and rejections
- Conducts a benefits investigation, updates patient accounts with accurate information gathered and relays information to appropriate team(s)
- Processes adjudication rejections, insurance terminations and insurance changes in a timely manner
- Assists with handling patient benefit statement questions to a conclusion
- Submits claims via electronic NCPDP clearinghouse and/or medical billing website(s)
- Works rejected claims in electronic NCPDP clearinghouse and/or medical billing website(s) to ensure they are received correctly, successfully and timely by our payers
- Works as a team to achieve company AR goals
- Has a general understanding of payer contracts and the claims submission requirements for each
- Bills secondary claims and ensures timely filing limits are not exceeded
- Assists in the reversal and rebilling of electronic NCPDP claims for corrections and proper payer adjustments. This includes, but is not limited to; rebilling to maximize reimbursement due to AWP increases, initial claims’ quantity and days’ supply issues, secondary rebilling, tertiary billing, reversals, payer rebilling requests, etc.
- Coordinates with the pharmacy in handling medication returns and addressing delivery ticket assignment as appropriate
- Reviews previous days’ shipments in the A/R Manager to confirm that all payer opportunity has been maximized
- Identify inconsistencies in following the proper billing processes and escalates to their supervisor
- Monitors Billing Review Manager and Ready to Bill Manager queues to be alerted of any necessary rebilling to appropriate payer
- Address delivery ticket assignment on partial ships and reshipment of medication
- Maintain current knowledge of, and comply with established policies and procedures including patient confidentiality/patient rights, government, insurance, and third party payer regulations
- Run reports and analysis on current and outstanding AR; prioritizes focus on accounts as directed ,always focusing on oldest A/R as an unspoken rule
Professional Competencies:
- Accomplished with MS Excel, Word, and Outlook
- Self-initiative
- Demonstrated ability to meet tight deadlines
- Ability to work with all levels of internal management and staff, as well as outside clients and vendors
- Strong oral, written, and interpersonal skills
- Attention to detail with emphasis on organizational skills
Required Qualifications:
- One (1) year of experience billing electronic insurance claims, including Medicaid, Medicare, and Commercial insurance via NCPDP clearinghouse. Medical billing experience preferred.
- Working knowledge of the healthcare industry
- HIPPA trained and/or the ability to work with and protect highly confidential patient and employee information.
- Experience working with clearinghouses for claims adjudication
- Six (6) months to one year phone-based customer service
- Ability to read and interpret an Explanation of Benefits
Educational Requirements:
- High School Diploma or equivalent
- Knowledgeable in Specialty Pharmacy and Infusion Pharmacy daily operations
License or Certification Requirements:
- None
Physical Requirements:
- The person in this position must move inside the office to access equipment.
- Constantly operates a computer and other office productivity machinery, such as a calculator, copy machine, and computer printer as job needs dictate.
- The ability to communicate information and ideas so others will understand. Must be able to exchange accurate information in these situations.
- The ability to observe details at close range (within a few feet of the observer).
- Required to stand, walk, and sit; talk or hear in person and by telephone; use hands to finger, handle, and feel objects or controls; reach with hands and arms. Regularly required to stoop, kneel, bend, and crouch with some lifting up to 15 pounds.
- Specific vision abilities required by this job include close vision, distance vision, depth perception, and the ability to adjust focus to review records and documents supplied by patients, physicians, pharma or contracts.
Working Conditions:
Typical indoor office environment conditions.
Equipment Used to Perform the Job:
Computers, keyboards, mouse, monitors, fax, and/or headsets for phone work. Software specific to the position, including but not limited to Microsoft Outlook, teams, WORD, and Excel.
Contacts:
Interact frequently with co-workers, internal company staff, managers, leaders, insurance providers, payers, vendors, and customers. This is not an exhaustive list of contacts and is subject to changes and alternatives.
Confidentiality:
The incumbent must maintain the confidentiality of personal information for the applications and licensing requirements, including any financial, strategic, or proprietary information. The Company does not consider this an exhaustive list of examples and may add or modify as deemed appropriate to the execution of the role.
This is not intended to be an all-encompassing list of duties. The job mentioned above is to be used as a guide to assist in accomplishing company objectives, covering only primary functions and responsibilities. Amber Specialty Pharmacy/Hy-Vee Pharmacy Solutions retains the right to change or assign other duties to the job as business needs to evolve or change.
Candidates must be able to pass a pre-employment drug test, background check, and health screening (if applicable).
Apply now and join our mission to provide exceptional patient care!
