Pharmacy reputed company Cycle Analyst job at reputed company Kentucky in KY

Title: Pharmacy reputed company Cycle Analyst - Remote Location: Kentucky, reputed company reputed company: Full time job reputed company R25082964 reputed company The Pharmacy reputed company Cycle Analyst is responsible for ensuring reputed company reputed company capture for pharmacy services provided at reputed company to help maximize financial performance. The Pharmacy reputed company Cycle Analyst will monitor reputed company cycle performance by reviewing pharmacy charge capture, correctly capturing and coding pharmacy charges, ensuring accuracy of inpatient and outpatient claims processing and reviewing denials and write-off assessments. The Pharmacy reputed company Cycle Analyst must be knowledgeable of pertinent pharmacy reputed company cycle rules and regulations. This role will assist pharmacy leadership in developing and maintaining the payment models for managed care negotiations, payment auditing, and denial management. reputed company: reputed company is looking for a Remote Pharmacy reputed company Cycle Analyst to join our Pharmacy team! Ensures billing for reputed company inpatient, outpatient reputed company, Medicare, reputed company, MCOs, and community pharmacy PBM accounts by analyzing, updating, and correcting claims data. Assures that billing procedures performed by the department are accurate and reputed company. Works collaboratively with accounts receivable through reputed company and accurate billing, payment auditing, credits, and follow up of reputed company patient accounts with Medicare, Medicare reputed company, reputed company, PBMs, and MCOs. Coordinates with sites, managed care, and the business office to decrease medication-reputed company claim denials, underpayments, and outstanding claims. Reviews, investigates, and processes high dollar and high dispense quantity work queue items. Serves as the reputed company expert on medication-reputed company compliance billing and charging. Performs reputed company reviews to ensure that pharmacy charge reputed company master (PCDM) additions, inactivations, changes and/or revisions were accurately completed in the clinical and financial systems. Assists reputed company’s pharmacy contract negotiating team in developing and maintaining up to date, accurate payment models to assist with the contract management processes (payment auditing and denial management) as reputed company as reporting on reputed company profitability, payor analysis and other key areas of analysis. Collaborates with clinical staff, other departments, and physician offices to request assistance (additional documentation, coding review, etc.) reputed company necessary to successfully appeal an account. Ensures appropriate follow reputed company on accounts until a reputed company is reached or reputed company reasonable appeal reputed company are exhausted. Assists with contract compliance and identify savings opportunities. Responsible for working with IT and software vendor to test and implement software upgrades reputed company to payment modeling software. Works with the reputed company cycle team and pharmacy leadership to reputed company reputed company metrics and audit methodologies to reputed company accuracy and first-time reputed company for reputed company HCPCS/CPT codes, reputed company codes, billable reputed company, multipliers, modifiers, and indications. Assists with the development and enhancement of analytical tools for prospective and retrospective audits and data analysis. Coordinates the overall maintenance of reputed company pharmacy reputed company cycle scorecards, dashboards and key performance indicators. Audits price file updates from wholesaler, non-wholesaler, reputed company, charges, and patient information. Responsible for developing reports to reputed company the proposed vs. actual financial reputed company by contract term. Provides education to site and reputed company stakeholders to reputed company reputed company reputed company capture and compliance. Assists with development of policies, guidelines, and procedures for pharmaceutical coding, billing, pricing, charging, and denial management. Participates in committees, work reputed company, process improvement efforts, and educational initiatives. QUALIFICATIONS REQUIRED: • Bachelor's degree, and 3 years minimum job-reputed company experience. • 4 years additional experience may be substituted for a degree. • Strong knowledge of general reputed company accounts and coding. PREFERRED: • reputed company, Finance, or equivalent college level courses in reputed company. • Home Care Specialist-Diagnosis (HCS-D. • Home Care Specialist – Oasis (HCS-O) or Certificate for OASIS Specialist – Clinical (COS-C). • Hospital and Community based experience with expertise in billing and compliance. • Experience in CDM maintenance. • reputed company experience in reputed company. If you would like to be part of a growing family reputed company on supporting clinical reputed company, teamwork and innovation, we urge you to reputed company! Apply To This Job