Description

Description Provide analysis and demonstrate understanding of pharmacy revenue cycle management to optimize the payment cycle for retail and specialty pharmacy claims. Ensure maintenance and understanding of the overall workflow of pharmacy accounts. Review payments for accuracy, ensure collection according to contracts, understand and follow-up with insurance companies to leverage the revenue process. Utilize preferred collection procedures to obtain third party payments and ensure compliance with payer contracts. Ensure accuracy of secondary billing processes and related vendor data feeds into systems as required. Advocate on behalf of MSHS to ensure the most efficient processes regarding claim resolution. Evaluate denials, short-pays and rejections. Provide proactive and ongoing follow-up and problem solving with insurance companies and pharmacy sites to identify trends, communicate proactively, and ensure accuracy in the process. Contribute to scalable process improvement to advance external revenue from the national strategy platform with pharmacy business office services. Responsibilities Understand the overall workflow to proactively solve problems, provide analysis and evaluate ...