RCM Analyst at Shields Health Solutions

Boston, Massachusetts, United States -

Full Time

Start Date

Immediate

Expiry Date

20 Jan, 26

Salary

0.0

Posted On

22 Oct, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Revenue Cycle Management, Billing Compliance, Operational Workflows, Claims Investigation, Medicare Billing, Insurance Partnerships, Reporting Metrics, Communication Skills, Problem Solving, Data Analysis, Pharmacy Systems, Root Cause Analysis, Collaboration, Microsoft Office Suite, Pharmacy Dispensing Systems, AR Reconciliation Systems

Industry

Hospitals and Health Care

Description

Job Purpose: Reporting to the Revenue Cycle Manager, the Revenue Cycle Analyst responsibilities include overseeing the pharmacy revenue cycle management functions on behalf of each partnering health system. This may encompass performing revenue cycle activities for various health system partners, working in a variety of third-party receivables platforms, and supporting management and our clients in various projects Job Duties: Manage and oversee payer and patient revenue cycle management processes for various hospital specialty pharmacy accounts; Develop operational/financial workflows to ensure billing compliance, identify efficiencies, maximize collectability, and reduce/prevent financial loss; Investigate outstanding claims receivables (under/overpayments) unpaid claims or recouped payments specific by payer/PBM/site for collectability; Manage Medicare B billing for each hospital specialty pharmacy partner by coordinating communications as it pertains to denials, patient eligibility and status, CMS compliance documentation needs, etc. Develop strong partnerships with 3rd party Insurance payers and PBM's, our clients and internal departments that support RCM functions Manage, prepare and review monthly reporting metrics for internal and external stakeholders. Respond to inquiries from various PBMs, State Medicaid(s), and our health system partners as well as internal departments Assist in implementation and on-boarding of revenue cycle management processes and resources for various hospital specialty pharmacy partnerships. Learn to navigate hospital electronic medical record systems (i.e., Allscripts, Cerner) and pharmacy systems (i.e., RX30, QS1, ScriptPro, Epic, etc.). Have a deep understanding of the unique requirements related to specialty pharmacy billing; Perform additional duties or project work as assigned by revenue cycle leadership Qualifications/ Education: Bachelor’s Degree or equivalent work experience required Strong knowledge of revenue cycle process and working with third party insurance and government payers Ability to work independently with minimal supervision Strong oral and written communication skills Demonstrated prior success working in a high-volume environment and with streamlining process using data Strong problem-solving capabilities. Ability to perform root cause analysis when determining areas of opportunity to improve results Collaborates well with other members of formal and informal groups in the pursuit of common goals. Applicants with knowledge of pharmacy dispensing systems and AR Reconciliation systems preferred Microsoft Office Suite experience, especially proficiency in Excel California residents employed by or applying for work at Shields have certain privacy rights. Please review our: California Workforce Privacy Notice and Privacy Policy. By providing your mobile number, you agree to receive text messages from Shields Health Solutions related to job opportunities, interview scheduling, and recruiting updates. Message and data rates may apply. You may opt out at any time by replying 'STOP.' Consent is not a condition of employment. Shields Health Solutions provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Responsibilities

The RCM Analyst will oversee pharmacy revenue cycle management functions for various health system partners, ensuring compliance and maximizing collectability. Responsibilities include managing billing processes, investigating claims, and developing operational workflows.