CompleteRx has an opening for a Revenue Integrity Specialist to help provide exceptional patient care at Upper Allegheny Health System, primarily located in Olean, NY. Under the supervision of the Health System Pharmacy Director, the Revenue Integrity Specialist is responsible for assisting with all aspects of the Pharmacy Revenue Cycle process.

We have a hybrid career opportunity that allows you to work two days a week at Olean General Hospital in Olean, NY and the rest of the week from home. You have the flexibility to work either the 7:30am - 4:30pm or 8am - 5pm shift. We highly encourage candidates with pharmacy technician experience (preferably in an acute care setting) or medical coding and/or billing experience to apply.

Compensation

• $20.00 - $27.00 per hour

Key Factors:

• Utilizes data provided through pharmacy systems as well as additional software to generate reports and Key Performance Indicators (KPI) for leadership.
• Prepares reports and provides analytic support as required.
• Trains staff on pharmacy revenue cycle processes and systems.
• Minimizes avoidable 3rd party medication insurance payment rejections.
• Explains all pharmacy revenue cycle related questions with accuracy and acquired knowledge.
• Promotes a positive company image and demonstrates professionalism during interactions with internal and external customers.
• Mentors and educates pharmacy technicians on related matters.

Hospital Overview:

Olean General Hospital is a member of Kaleida Health in Buffalo and part of Upper Allegheny Health System which includes Bradford Regional Medical Center. OGH offers the most comprehensive care of any hospital in Southwestern New York and is always evolving to provide the latest advancements in healthcare.

What You Will Do

Pharmacy Revenue Cycle Monitoring:

• Timely and accurately complete identification and submission of prior-authorization and medical necessity requests to payors.
• Research patient accounts to correct invalid and/or missing authorization information - interact with clients, providers, insurance companies, patients, and sales representatives, as necessary, to request required information and document in patient charts.
• Identifies pharmacy revenue cycle trends for outlier billings - Research outliers and make corrections necessary to ensure accuracy of billings and optimize reimbursement.
• Document eligibility, benefit, and authorization information in accordance with established guidelines.
• Complete insurance verifications accurately and timely.
• Verify that prior authorizations and/or pre-service requirements are met.
• Proactively manage and maintain all outstanding authorization accounts to minimize billing rejections.
• Notify all patients and providers of any significant gaps in coverage and/or high co-pays or deductibles prior to services being rendered.
• Provide outstanding customer service to patients; develop and maintain positive working relationships with internal and other external customers.
• Identify and report trends and issues related to billing and reimbursement.
• Manages inbound calls from patients, physicians, practitioners, and clinics regarding inquiries about services provided, financial responsibility and insurance coverage.

Regulatory compliance: (Maintain professional competencies).

• Ensures applicable Continuing Education (CE) records and certification/licensure are maintained.
• Complete and pass all competency/skills assessment requirements.
• Attend all required department meetings, orientation, education, and training sessions as required.
• Review literature and other materials pertinent to the practice of pharmacy; stay current on pharmacy knowledge.
• Maintains strict confidentiality of patient, visitor, and employee information to comply with HIPAA Privacy Rule standards.

Recordkeeping:

• Maintain logs, records, and other required documentation accurately and on a timely basis.
• Maintain files in appropriate locations.

Operations:

• Provide pharmacy staff with appropriate data reports as directed.
• Provide pharmacy staff with education, training, and support regarding revenue cycle process.
• Conduct quality audits, collect data and complete documentation related to the revenue cycle management process as assigned.

Customer Service:

• Answer the telephone identifying self and department. Direct calls to appropriate staff.

• Adhere to the CompleteRx, LTD Team Covenant Participates in orientation, education, and training programs.

Qualifications:

• High school diploma or equivalent required; bachelor's degree preferred.
• Previous pharmacy technician experience (preferably in an acute care setting) or medical coding and/or billing experience preferred.
• ASHP Pharmacy Revenue Cycle Management Certificate preferred.
• Successful completion of a formal Pharmacy Technician training program preferred.
• Possess current CPhT certificate from PTCB or similar certification agency preferred.

Compensation & Benefits:

As an employee of CompleteRx, your commitment to learning will be encouraged and supported through ongoing training and professional development. We nurture a collaborative, high-performance culture and offer a challenging career along with a comprehensive benefits package.

• Medical, dental, and vision
• Flexible Spending Account or Health Savings Account
• Vacation and sick time
• Continuing education: Eligible employees have access to a full complement of continuing-education courses as well as a wide variety of career development opportunities.
• 401(k) plans: CompleteRx offers a 401(k) plan with a company match.
• License Reimbursement
• Short and Long-Term Disability

Company Description:

Founded in 1998 as a service-driven organization with a strong sense of community, CompleteRx embarked on a strategy to become the employer of choice in hospital pharmacy management and consulting. Since our founding, we believe our success has been driven by our employees who are our most valuable resources. We believe the very best outcomes are accomplished when all employees share a sense of mutual ownership for successful results and where each employee accepts personal accountability for their individual contributions. These beliefs are the core of our Team Covenant which guides all of our actions to the patients we care for, hospitals we support, and fellow employees we work alongside.

CompleteRx is an Equal Opportunity Employer by choice.