Revenue Integrity Analyst

Hy-Vee, Inc.•Omaha, NE

2d•Onsite

About The Position

The Revenue Integrity Analyst will perform functions to ensure all necessary information is entered into the patient account to maximize reimbursement of all claims billed by the Company. This includes obtaining accurate insurance information using multiple methods and entering it in the correct payer sequence. The Revenue Integrity Analyst also gathers the necessary information to bill electronic NCPDP claims, reviews statements to determine accuracy, assists patients and caregivers with navigating financial assistance programs when needed, ensures the accurate correction of claims processing, whether electronic pharmacy claims or medical claims, and ensures that confirmation of delivery tickets is handled timely and appropriately. It is the goal of the Revenue Integrity Analyst to make corrections and identify where there is the potential for increased efficiencies, all while communicating with coordinators, payers, and co-workers using exceptional customer service and professionalism, all while ensuring the integrity of all revenue streams. Amber Specialty Pharmacy/Hy-Vee Pharmacy Solutions retains the right to change or assign other duties to the job as business needs to evolve or change.

Requirements

One (1) year of experience billing electronic insurance claims, including Medicaid, Medicare, and Commercial insurance via NCPDP clearinghouse.
Medical billing experience preferred.
Working knowledge of the healthcare industry.
HIPPA trained and/or the ability to work with and protect highly confidential patient and employee information.
Experience working with clearinghouses for claims adjudication.
Six (6) months to one year phone-based customer service.
Ability to read and interpret an Explanation of Benefits.
High School Diploma or equivalent.
Knowledgeable in Specialty Pharmacy and Infusion Pharmacy daily operations.
Must pass post-offer, pre-employment drug background tests as allowed by state, federal, local ordinance, statutes and licensing/accreditation requirements.
Candidates must be able to pass a pre-employment drug test, background check, and health screening (if applicable).

Nice To Haves

Medical billing experience

Responsibilities

Perform functions to ensure all necessary information is entered into the patient account to maximize reimbursement of all claims billed by the Company.
Obtain accurate insurance information using multiple methods and enter it in the correct payer sequence.
Gather necessary information to bill electronic NCPDP claims.
Review statements to determine accuracy.
Assist patients and caregivers with navigating financial assistance programs when needed.
Ensure the accurate correction of claims processing, whether electronic pharmacy claims or medical claims.
Ensure that confirmation of delivery tickets is handled timely and appropriately.
Make corrections and identify potential for increased efficiencies.
Communicate with coordinators, payers, and co-workers using exceptional customer service and professionalism.
Ensure the integrity of all revenue streams.
Contacts the patient, when necessary; to gather insurance and billing information or notify of a delay in processing.
Contacts the patient and/or payer to resolve all types of payer and/or coverage issues and rejections.
Conducts a benefits investigation, updates patient accounts with accurate information gathered and relays information to appropriate team(s).
Processes adjudication rejections, insurance terminations and insurance changes in a timely manner.
Assists with handling patient benefit statement questions to a conclusion.
Submits claims via electronic NCPDP clearinghouse and/or medical billing website(s).
Works rejected claims in electronic NCPDP clearinghouse and/or medical billing website(s) to ensure they are received correctly, successfully and timely by our payers.
Works as a team to achieve company AR goals.
Has a general understanding of payer contracts and the claims submission requirements for each.
Bills secondary claims and ensures timely filing limits are not exceeded.
Assists in the reversal and rebilling of electronic NCPDP claims for corrections and proper payer adjustments. This includes, but is not limited to; rebilling to maximize reimbursement due to AWP increases, initial claims’ quantity and days’ supply issues, secondary rebilling, tertiary billing, reversals, payer rebilling requests, etc.
Coordinates with the pharmacy in handling medication returns and addressing delivery ticket assignment as appropriate.
Reviews previous days’ shipments in the A/R Manager to confirm that all payer opportunity has been maximized.
Identify inconsistencies in following the proper billing processes and escalates to their supervisor.
Monitors Billing Review Manager and Ready to Bill Manager queues to be alerted of any necessary rebilling to appropriate payer.
Address delivery ticket assignment on partial ships and reshipment of medication.
Maintain current knowledge of, and comply with established policies and procedures including patient confidentiality/patient rights, government, insurance, and third party payer regulations.
Run reports and analysis on current and outstanding AR; prioritizes focus on accounts as directed ,always focusing on oldest A/R as an unspoken rule.