340B Accountant; HSO Pharmacy; Mount Sinai Health System; Full Time; Days

Mount Sinai Health System; New York (NY); On-site; USD 60,000 - 100,000; Full time

Job summary

An established industry player in healthcare is seeking a dedicated 340B Accountant to enhance pharmacy revenue cycle management. This role involves analyzing payment processes, resolving discrepancies, and advocating for efficient claim resolutions. Join a team committed to innovation and excellence in patient care, where your insights will contribute to scalable process improvements and operational success. This is an exciting opportunity to make a significant impact in a dynamic environment focused on fostering growth and inclusivity.

Qualifications

• 3+ years of experience in healthcare reimbursement analysis and revenue cycle knowledge.
• Experience with Medicare, Medicaid, and commercial payers preferred.

Responsibilities

• Analyze and evaluate trends in the revenue cycle to optimize payment processes.
• Communicate with pharmacy staff and insurance companies to resolve payment discrepancies.
• Generate reports and perform financial impact analyses on payment variances.

Skills

Healthcare reimbursement analysis

Revenue cycle management

Problem-solving

Data analysis

Communication with insurance companies

Education

Bachelor’s degree in business or healthcare

Equivalent experience

Job description

340B Accountant; HSO Pharmacy; Mount Sinai Health System; Full Time; Days

Join to apply for the 340B Accountant; HSO Pharmacy; Mount Sinai Health System; Full Time; Days role at Mount Sinai Health System

Job Description

Provide analysis and demonstrate understanding of pharmacy revenue cycle management to optimize the payment cycle for retail and specialty pharmacy claims. Ensure maintenance and understanding of the overall workflow of pharmacy accounts. Review payments for accuracy, ensure collection according to contracts, and follow up with insurance companies to leverage the revenue process. Utilize preferred collection procedures to obtain third-party payments and ensure compliance with payer contracts. Ensure accuracy of secondary billing processes and related vendor data feeds into systems as required. Advocate on behalf of MSHS to ensure efficient claim resolution processes. Evaluate denials, short-pays, and rejections. Provide proactive follow-up and problem solving with insurance companies and pharmacy sites to identify trends, communicate proactively, and ensure process accuracy. Contribute to scalable process improvements to enhance external revenue from the national strategy platform with pharmacy business office services.

Responsibilities

• Understand the overall workflow to proactively solve problems, analyze, and evaluate trends in the revenue cycle.
• Reconcile payer remittances and understand payer denials and their impact on revenue and margins.
• Resolve 835 remittance issues such as unapplied cash, claim exceptions, and partial pays.
• Analyze payments, evaluate contracts, and proactively resolve issues to optimize the pharmacy claim payment cycle.
• Communicate with pharmacy staff, revenue integrity teams, and insurance companies to escalate and resolve payment discrepancies.
• Analyze reimbursement arrangements and operational issues affecting financial results.
• Achieve department metrics such as DSO, aged accounts receivable, timely secondary billing, and applied cash targets.
• Review payment accuracy, follow up with payers, and ensure compliance with regulatory requirements.
• Use data for projections, perform financial impact analyses, generate reports on payment variances, and review aging reports.
• Generate manual and online billing for outstanding balances, review payment processes, and coordinate payer/provider relations.
• Identify trends, communicate findings, and make recommendations for process improvements.
• Attend meetings with payer representatives to discuss discrepancies and develop action plans.
• Contribute insights to improve revenue cycle processes and collaborate on developing new capabilities.

Qualifications

• Bachelor’s degree in business, healthcare, or related field, or equivalent experience.
• Minimum three years of healthcare reimbursement analysis, collection experience, or revenue cycle knowledge.
• Five years of pharmacy reimbursement analysis and collection experience with Medicare, Medicaid, PBMs, and commercial payers. Pharmacy dispensing knowledge preferred.
• Registered Technician preferred.

Employer Description

The Mount Sinai Health System is committed to fostering an inclusive environment that promotes excellence, innovation, and outstanding patient care. We value diversity and strive to create a workplace where everyone can contribute and grow. Join us to be part of a legacy of achievement and transformation in healthcare.