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Claims Analyst (Home Plus Pharmacy)
Regional Health
Regional Health
 

Job Location: Rapid City, SD
Job Type: Full time
Hours: Scheduled Weekly Hours

40


Department: Home+ RC Home Infusion Pharmacy
Scheduled Weekly Hours:
40
Shift:
Day (United States of America)

Job Summary:

Performs those duties necessary to ensure the proper billing, payment processing, reconciliation, and end of month processing for pharmacy services within Regional Health Home Plus. Work closely with Staff Accountant and Pharmacy Specialist.

Job Description:

Essential Functions:
  • Conducts timely follow up of claims as needed.
  • Informs department manager of Emdeon issues in a timely manner.
  • Integrates compliance standards and payer specific data to properly file claims.
  • Attends mandatory training sessions as directed by the Corporate Compliance Officer and the Billing Compliance Officer as recorded in the education logs.
  • Maintains and updates appropriate system documentation to provide information regarding claim processing to internal or external customers.
  • Participates in Emdeon training sessions as required.
  • Completes reminders received per department guidelines. A Follows the guidelines created to maintain resolution to account issues in a timely manner.
  • Identifies patterns of claim submission issues that might require Compliance and Charge master staff to resolve. Identifies patterns of claim submission issues that might require HIPAA transaction code set review. Informs staff of status of issues. A Uses tools provided to trend and track patterns related to monthly submission of claims. Demonstrates ability to explain issues to leadership. E Addresses situations from trend and tracking patterns. Research payor requirements and offer suggestions to leadership. Communicates verbally in a clear, concise manner. Provides clear guidelines and directions when communicating to others.
  • Responsible for accurate, timely filing of claims in accordance with established guidelines and compliance regulations.
  • Responsible for personal organization of activities and adherence to personnel policies and procedures.

    Additional Requirements:

    Sedentary work - Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

    Qualifications:



    Employee Benefits:
    Regional Health offers a highly competitive and comprehensive benefits package that looks out for you and your family. We recognize there are many types of families, with many different needs. That's why our plans are flexible, allowing you to select the individual benefits which fit your personal needs.

    Regional Health is an integrated health care system with the purpose of helping patients and communities live well. The organization, with headquarters in Rapid City, S.D., provides community-based health care in more than 20 communities in two states and 32 specialty areas of medicine. As the largest private employer in western South Dakota, Regional Health is comprised of five hospitals, 24 clinic locations and employs nearly 5,000 physicians and caregivers. Regional Health is committed to the future of medicine, with medical training partnerships, a medical residency program, and more than 130 active research studies.

    How to Apply:





    Regional Health

    Come join us in our pursuit to become the best healthcare system in America!
    Regional Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected Veteran status.

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