Revenue Cycle Specialist - Pharmacy - Reside in Colorado -Hybrid

We are recruiting for a motivated Revenue Cycle Specialist - Pharmacy - Must Reside in Colorado
-Hybrid to join our team!

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Department

Job Summary

The Pharmacy Revenue Cycle Coordinator is responsible for collection and reimbursement activities related to the DHHA pharmacy and DHHA Retail Pharmacy. The person in this position will work to coordinate statement billing activities, account flow to external agencies and facilitate billing and reimbursement knowledge between Hospital and Physicians Business Services (HPBS) and both the Hospital and Retail Pharmacies. This position is responsible for the management of the self-pay account activities located in the retail pharmacy service area.

assuring that accounts receive statements are flow to the SBO vendor and ultimately to the bad debt vendor. This position knows the revenue cycle well enough to play a role in pharmacy coding, modifier usage and ultimately code placement on the claim. This position will also understand payer behavior enough to be able to estimate reimbursement for particular drugs, especially 340-B drugs and IV therapy.

The position will report to the director of HPBS but will network with pharmacists, charge master and coding personnel, vendor management staff and other HPBS staff. The position is self-directed but will be required to meet targets in the Pharmacy Service Area in the Epic physician (PB) billing system.

Essential Functions
:

• Monitor the workflow for self-pay accounts with balances as they go from billed Accounts Receivable (AR) to Bad Debt (BD). Assuring that balances are accurate as they transition in each stage of the workflow. (25%)
• Assure that AR moving from the pharmacy insurance billing system to Epic is reconciled and insurance takebacks are resolved, and the AR is billed to the patient. (15%)
• Understands pharmaceutical reimbursement for the major payers, Medicaid, Medicare, Aetna, Anthem, United Healthcare, and Cigna. And is able to communicate with the pharmacy the expected payment for drugs and biologicals This will include understanding of reimbursement for high-cost drugs used in IV infusion and cancer treatment. (20%)
• Understand and recommend actions required for the correct billing to the major payers, Medicaid, Medicare, Aetna, Anthem, United Healthcare, and Cigna. And is able to communicate with the pharmacy the expected payment for drugs and biologicals This will include understanding of reimbursement for high-cost drugs used in IV infusion and cancer treatment. (20%)
• Resolve any credit balances in Epic (20%)

Education
:

• Bachelor's Degree a bachelor's degree in finance, business administration, healthcare administration, nursing, or a related field Required
• Master's Degree Preferred
• A hospital or medical coding certificate preferred

Work Experience
:

• 4-6 years billing hospital, medical or physician Required and
• less than 1 year Billing for pharmaceutical claims
  - preferred

Licenses
:

• PTCB Education/Training Certificate - PTCB - Pharmacy Technician Certification Board Required

Knowledge,

Skills and Abilities

:

• A firm understanding of Medical and Hospital coding a coding certificate would be helpful in verification of this skill
• Knows the basic formats of the UB04 and the HCFA 1500, with their various fields and form locators
• Knows the revenue cycle and where most opportunities for improvement happen

Shift

Work Type

Salary

Benefits

• Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to 9.5%, and generous medical plans

• Free RTD Eco Pass (public transportation)

• On-site employee fitness center and wellness classes

• Childcare discount programs & exclusive perks on large brands, travel, and more

• Tuition reimbursement & assistance

• Education & development opportunities including career pathways and coaching

• Professional clinical advancement program & shared governance

• Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program

• National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

Our Values

• Respect

• Belonging

• Accountability

• Transparency

All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.

Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver's 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, a Public Health Institute, an HMO and The Denver Health Foundation.

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