Outpatient Retail Pharmacy AR Lead

HHC•Indianapolis, IN

About The Position

Eskenazi Health serves as the public hospital division of the Health & Hospital Corporation of Marion County. Physicians provide a comprehensive range of primary and specialty care services at the 333-bed hospital and outpatient facilities both on and off of the Eskenazi Health downtown campus including at a network of Eskenazi Health Center sites located throughout Indianapolis. The Outpatient Retail Pharmacy AR Lead serves as a liaison between Cash Management, Outpatient Retail Pharmacy Leadership, Revenue Cycle Leadership, Auditors, Vendors, and Pharmacy Payers. This position takes a leadership role in working all levels of Outpatient Pharmacy AR within the Revenue Cycle; to include payment posting, no response follow-up, credit balance review, and facilitating rebilling of outpatient pharmacy claims when appropriate. Proactively contributes to Eskenazi Health’s mission: Advocate, Care, Teach and Serve with special emphasis on the vulnerable population of Marion County; models Eskenazi Health’s values

Requirements

Minimum 4 years Revenue Cycle experience
Associates Degree or two years post-secondary education preferred
Knowledge of EPIC, WAM, NThrive, NetRX, Emdeon, Fifth Third Direct, Pharmacy Payer Contracts, SharePoint, Microsoft Office products to include proficiency in Excel.
Ability to adapt and learn software quickly, read and accurately interpret contracts and payor guides
Ability to work independently and with a team, respond to changes in work process, leadership, and systems in a proactive, constructive manner
Ability to present data to leader groups with clarity and efficiency

Nice To Haves

Retail Pharmacy Billing or Outpatient Pharmacy AR Management experience a plus

Responsibilities

Serves as the go-to person for Outpatient Retail Pharmacy Leadership and Revenue Cycle Leadership regarding Epic AR management of Outpatient Pharmacy claims
Regularly reviews Pharmacy ATB to determine areas of needed improvement or change within the patient accounting system, communicates unusual payor activity or non-standard trending to appropriate leaders
Directs and reviews analyses, reporting, key performance indicators and operational metrics
Accurately post all Outpatient Retail Pharmacy payments, discounts, and denials for both ERA and Manually keyed payments within 24 hours of deposit/receipt.
Review Outpatient Retail Pharmacy accounts with no response from payor, contacting payor for updates on payment and/or work with clearing house vendor researching payment data
Provide review of Dose Pack accounts prior to statement data run to ensure accuracy of program billing data
When necessary, Retrieve and Upload Electronic Remittance Advices from vendor site ensuring proper splits between patient account data, provider adjustment (PLB) entries, and error reporting data
Verifies selection of appropriate account by date of service, RX number, and /or charge line detail to ensure proper payment/discount application
Adapts to varying EOB formats and payor reason codes in order to accurately document payment, contractual, or patient responsibility
Works Epic error report (.1 report) immediately to ensure deposit items are resolved timely and are posted in full.
Reviews no-response claims and researches with NetRx and Payor to determine next course of action to resolve claim
Works payment undistributed WQ, assessing root causes for undistributed dollars and opens tickets with Epic when appropriate to initiate further review and resolution of root cause
Regularly meets with Cash Management and Epic team members to review issues and trends, and brings them to management team with suggestions/solutions for resolution
Troubleshoots current problems and anticipates potential problems, and resolves them by involving appropriate departments and personnel as needed, with the expertise to know when to collaborate with others to minimize loss of revenue, reimbursement, penalties or sanctions
Stays current on industry changes in the Outpatient Retail Pharmacy space, adapting to changes in payor mix and payor requirements
Complies with all Federal, State, and Carrier specific rules, regulations and requirements related to health care billing