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Reimbursement/Billing System Analyst - Remote
Category: Health Care Industry
  • Your pay will be discussed at your interview

Job code: lhw-e0-89753099

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Option Care

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  Job posted:   Thu May 17, 2018
  Distance to work:   ? miles
  1 Views, 0 Applications  
Reimbursement/Billing System Analyst - Remote
Option Care is a healthcare services company that at its core delivers high quality, cost effective infusion services through trusted partnerships across the healthcare system, resulting in outcomes that make a positive difference in people's lives.

Job Description Summary:**

Responsible for preparing third party payer agreements to load in the pharmacy management system for Option Care. Responsible for building the third party payer agreements in the pharmacy operations system (CPR Plus). Research, understand, and interpret the applicable billing rules, billing units, and terms and conditions of the agreement in order to drive success in billing and collecting on the services provided by Option Care. Supports the Managers and Directors within the Commercial Contracting group facilitating a cross functional and collaborative working relationship with Contracting, Pricing, Trade, and Revenue Cycle Management. Collaborate closely with the Contract Operations Department, as well as Revenue Cycle Management and the CMCs.

**Job Description:**

**Job Responsibilities (listed in order of importance and/or time spent)**

+ Create and build the record for third party payer contract agreements. This includes creating insurance plans, researching and inputting business rules, and loading the contract pricing terms for implementation

+ Maintain assigned payer agreements. Update and execute any changes to pricing, coding, or business rules.

+ Responsible for working with the Contracting and Revenue Cycle Management on site integration to insure proper insurance plans are accounted for, and assigned to the correct location

+ Identify contracts that are not generating revenue to see if there is an opportunity to purge records and reduce insurance plan selection errors

+ Audit third party agreement pricing tables to ensure accuracy to improve Revenue Cycle Management success

+ Collaborate with Pricing team when trends are identified to insure proper insurance plan was utilized so that we are maximizing profitability by reducing bad debt and other payer adjustments

+ Collaborate with IT and Revenue Cycle Management on System Upgrades that could impact contract build, as well as make recommendations on system enhancement opportunities

+ Collaborate with Revenue Cycle Management to insure proper insurance plans are set up, and able to be utilized by CMC

+ Provide detailed advanced system reports for revenue cycle management and pricing teams as it relates to payer pricing strategies that are being input into the system

+ Assist with training of Contract System Management Specialists

**Supervisory Responsibilities**

Does this position have supervisory responsibilities? (i.e. hiring, recommending/approving promotions and pay increases, scheduling, performance reviews, discipline, etc.) No

**Basic Education and/or Experience Requirements**

+ Bachelor's degree, or High School Diploma with at least 5 years of experience in Revenue Cycle Management, Contract Management, Home Infusion intake, or home infusion pharmacy technician.

**Basic Qualifications**

+ Ability to work in a deadline driven environment

+ Strong analytical and problem solving skills

+ Ability to function individually as well as in cross-functional teams. Ability to identify improvement and growth opportunities

+ Advanced level skill in Microsoft Excel with an ability to do VLOOKUP up, basic formulas, and pivot table work.

+ Experience with analyzing and reporting data ability to identify issues, model trends, or exceptions to drive improvement of results and find solutions

+ Experience with HCPCS coding, and Drug Pricing Sources (AWP, ASP, WAC)

+ Intermediate level skill in Microsoft PowerPoint and Microsoft Word

**Travel Requirements: (if required)**

Willing to travel up to 10% of the time for business purposes (within state and out of state)

**Preferred Qualifications & Interests (PQIs)**

+ CPR Plus experience

+ Contract Management experience

+ Experience with Medicare, Medicaid, PBM, and other third party payer payment guidelines

_This job description is to be used as a guide for accomplishing Company and department objectives, and only covers the primary functions and responsibilities of the position. It is in no way to be construed as an all-encompassing list of duties._

_Option Care subscribes to a policy of equal employment opportunity, making employment available without regard to race, color, religion, national origin, citizenship status according to the Immigration Reform and Control Act of 1986, sex, sexual orientation, gender identity, age, disability, veteran status, or genetic information._

Option Care is a leading provider of home and alternate treatment site infusion services. With a staff of more than 1,700 clinical experts - including specially trained infusion nurses, infusion pharmacists and registered dietitians - Option Care treats patients with a wide range of acute and chronic conditions. Comprehensive therapy management programs are offered for patients with nutrition disorders, bleeding disorders and heart failure, as well as those needing immunoglobulin (IG) therapy and anti-infective therapy. Option Care is able to provide services to 92% of the nation's population through more than 90 infusion pharmacies and 100 alternate treatment sites across the country.

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