Claims Analyst Pharmacy Revenue Cycle

Claims Analyst Pharmacy Revenue Cycle, Boston Medical Center, United States (nationwide) (nationwide)

Position Summary

The Claims Analyst Pharmacy Revenue Cycle is a full-time position at Boston Medical Center. This role focuses on enhancing the pharmacy revenue cycle by pursuing insurance companies for payment or underpayment of services rendered and ensuring accurate reimbursement through correct contract terms, billing practices, and compliance with state and federal guidelines. The position requires an in-depth understanding of financial, pharmacy, and medical revenue cycle expertise to identify and recover overlooked revenue.

Day-to-Day Responsibilities

• Research, resolve, and prepare claims that have not passed the payer edits daily.
• Determine and initiate action to resolve rejected drug claims.
• Substantiate accurate reimbursement through correct contract terms, billing practices, and compliance with state and federal guidelines.
• Analyze, audit, problem solve, and reconcile accounts as critical components of the role.
• Conduct duties in accordance with industry, federal, and state billing guidelines and contractual obligations while adhering to department policies and procedures.

What You Bring

• Dedicated resources and collaborative approach to improving performance through fine-tuned workflows and routine updates to core systems.
• Extensive telephone and written correspondence skills for pursuing insurance companies for payment or underpayment of services rendered.
• Ability to analyze, audit, problem solve, and reconcile accounts as critical components of the role.

Why Join Boston Medical Center

Boston Medical Center offers significant opportunities within its Pharmacy Complex Claims team. The position brings traditional revenue cycle functions into the department of pharmacy, providing a unique blend of financial and healthcare expertise to identify and recover overlooked revenue for BMC. Our commitment to quality care for patients and communities is at the heart of our mission.

Next Steps

To apply, complete your application directly on this page, or you'll be redirected to the employer's application platform to finish submitting there.