Pharmacy Accounts Receivable Specialist Stoughton, MA

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

• 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/over payments) 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, Script Pro, 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

• 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

An employee in this position can expect a salary rate between $55,000 and $70,000 plus bonus pursuant to the terms of any bonus plan if applicable. The actual salary will depend on experience, seniority, geographic location, and other factors permitted by law.

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.