At Shields, we pride ourselves on our culture of inclusion and kindness and the difference we make in patients' lives every day. We are tremendously proud to be certified as a ‘Great Place to Work’ four years in a row. In 2022, we were awarded US Fortune Best Workplaces in Health Care™, Fortune Best Workplaces for Millennials™ & Fortune Best Workplaces for Women™.
Improving lives and elevating performance are at the heart of everything we do. That’s why more health system leaders trust Shields to elevate access, outcomes and growth within specialty pharmacy — delivering value throughout the entire health system. Leveraging our proven Shields Performance Platform – we deliver the financial results that health systems demand and the superior outcomes patients deserve. With the foremost leaders in specialty pharmacy on our team; proven success partnering with more than 70 health systems; and a vested interest in delivering measurable results – we are the partner health systems trust to transform their specialty pharmacy into a powerful growth engine and elevate performance where it matters most.
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.
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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.
