RCM Analyst - Shields Health Solutions

Job Purpose:
RCM Analyst responsibilities include overseeing the pharmacy revenue cycle management functions on behalf of each partnering health system. Candidate must be highly proficient in MS Office, particularly Excel and Word, and able to quickly learn other database programs. Strong organizational and interpersonal skills are a must.

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, specific to claims and payment inquiries
• Manage, prepare and review monthly reporting metrics for internal and external stakeholders;
• Perform any manual or specialized billing needs as required;
• 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;
• Protect organization's value by keeping information confidential;
• Other duties as assigned;  

Experience/ Education:

• Strong interpersonal communication skills, able to extract relevant information; strong organizational skills a must 
• Organized, high-integrity, attention to detail, dependable, quality focus, empathetic, good listener/communicator
• Strong problem-solving capabilities:  Anticipates, identifies and defines problems. Seeks root causes. Develops, recommends, and implements practical solutions.
• Collaborates with other members of formal and informal groups in the pursuit of common missions, vision, values and mutual goals.
• Discretion and confidentiality essential as position deals with highly sensitive and private data in a HIPAA compliant environment
• Applicants with knowledge of pharmacy dispensing systems and AR Reconciliation systems (i.e. Inmar, TPMS, RX30, EPIC, ScriptPro, QS1, etc.) and 3rd party payer reimbursement schedules as well as specialized medical or pharmacy claims billing and reconciliation experiences are preferred.