Revenue Integrity Analyst

Amber Specialty Pharmacy•Omaha, NE

1d•Onsite

About The Position

At Amber Specialty Pharmacy, our commitment to patient care is unmatched. Enjoy fulfillment in a career where you have the opportunity to make a positive impact on patients with complex and chronic conditions. 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.

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.
HIPAA 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.
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.
Work with all necessary computer software to perform job duties.
Contact the patient, when necessary, to gather insurance and billing information or notify of a delay in processing.
Contact the patient and/or payer to resolve all types of payer and/or coverage issues and rejections.
Conduct a benefits investigation, update patient accounts with accurate information gathered and relay information to appropriate team(s).
Process adjudication rejections, insurance terminations and insurance changes in a timely manner.
Assist with handling patient benefit statement questions to a conclusion.
Submit claims via electronic NCPDP clearinghouse and/or medical billing website(s).
Work rejected claims in electronic NCPDP clearinghouse and/or medical billing website(s) to ensure they are received correctly, successfully and timely by our payers.
Work as a team to achieve company AR goals.
Have a general understanding of payer contracts and the claims submission requirements for each.
Bill secondary claims and ensure timely filing limits are not exceeded.
Assist in the reversal and rebilling of electronic NCPDP claims for corrections and proper payer adjustments.
Coordinate with the pharmacy in handling medication returns and addressing delivery ticket assignment as appropriate.
Review 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 escalate to their supervisor.
Monitor 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; prioritize focus on accounts as directed, always focusing on oldest A/R as an unspoken rule.