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Fit if you like detailed payer rules, pharmacy billing complexity, and mission-driven hospital RCM at BMC’s academic safety-net environment. Less fit if you want pure clinical pharmacy or fully remote-only work (role listed non-remote, U.S.).
As a Claims Analyst focused on pharmacy revenue cycle at Boston Medical Center, expect work on pharmacy claim edits, denials, payer rules, and clean claim submission so drug-related charges post correctly. Typical day: queue review, root-cause denial analysis, payer portal follow-up, coordination with pharmacy and billing, and documentation for audit readiness in a large safety-net academic setting.
Strengthen: pharmacy claim coding/edits, payer policies (Medicare/Medicaid/commercial), denial appeals, Excel/reporting, and EHR/RCM systems. No cert list or costs in provided data—prioritize hands-on claims accuracy over unlisted credentials.
Pharmacy-related claims accuracy, denials, and revenue-cycle follow-through within BMC’s billing operations.
Yes—principal teaching hospital for BU’s medical school, with many training programs.
No salary or review ratings are in the provided data; verify pay and benefits with BMC directly.
Website: bmc.org
Boston Medical Center (BMC) is a non-profit 514-bed academic medical center and safety-net hospital in the South End neighborhood of Boston. As part of the Boston Medical Center Health System, the hospital provides primary and specialty care to residents of the Greater Boston area. It is also the principal teaching hospital of Boston University Chobanian & Avedisian School of Medicine and home to 66 residency and fellowship training programs.
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Claims Analyst Pharmacy Revenue Cycle, Boston Medical Center, United States 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.
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