Outpatient Retail Pharmacy AR Lead

FLSA Status

Nonexempt

Job Role Summary

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

Essential Functions and 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   
 

Job Requirements

•    Minimum 4 years Revenue Cycle experience 
•    Retail Pharmacy Billing or Outpatient Pharmacy AR Management experience a plus 
•    Associates Degree or two years post-secondary education preferred 
 

Knowledge, Skills & Abilities

•    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