The primary function of this role is to research and reconcile unapplied cash payments to open Accounts Receivable at the claim level. This may include applying payments, re-directing payments to other financial areas, or coding claims for refund. The associate will be required to follow all allocation and reconciliation of unapplied cash funds in accordance with PharMerica’s Cash Processing Center’s Policy and Procedures and the Consumer Credit Protection Act of 1977.
• Researches and takes necessary actions to resolve unapplied cash portfolio
• Determine if payments should be re-applied to claims or refunded to payer
• Reconciles payments to open AR at claim level
• Work with multiple internal databases and reporting tools (Cloud docs, Cognos, Access, etc.) to research and locate backup information to be sent to the cash team for payment posting
• Prioritizes workload and ensures cash is posted accurately and timely in accordance with the cash processing center standards through the AS400
• Understands different approaches to claim resolution based on internal coding of claim
• Associate may need to initiate refunds, provide detailed spreadsheets, research Provider Line Balance or provide other information to 3rd Party payers that will result in a successful reconciliation of funds
• Communicates with 3rd Party Payers, and internal departments to achieve appropriate posting or reconciliation of cash
• Collaborates with the Co-Pay Recovery Team to resolve co-pay balances and prevent write offs when the company has a payment in unapplied cash
• Print and key reversals of variance or write-off batches per guidelines of Sarbanes Oxley requirements and Signature Compliance in order to apply payments received after adjustment
• Works with Department Manager in identifying any payer issues that may require special attention or need escalation
• Works to understand specific reasons for failed electronic reconciliation or recoup through the 835 process and discusses opportunities for improvement with management
• Maintain and accurately report all reconciliation activity on monthly aging spreadsheets
• Record daily productivity results accurately in the Productivity Database
• Properly document all communication and follow up that is necessary to apply payment or produce refund
• Works through assignments independently and timely with limited direction
• Able to handle high volume and significant workload
• Work with 3rd Party Claims Reconciliation Supervisor and/or Manager on special projects as needed
• Works 835 exception shared e-mail box as needed
• Performs other related duties as assigned
• Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards
• Required: High School graduate, GED or equivalent experience
• Desired: Associates degree, 4 year college or technical degree
• Required: 1 year cash or claims reconciliation, Accounts Receivable and/or collections experience
• Desired: Third Party Billing or collections/billing experience in the healthcare industry
• Desired: Understanding of revenue cycle functions within pharmacy practice or equivalent setting
• Required: Proficiency in MS Office Products (Excel, Word) and basic computer knowledge
• Required: Excellent time management skills and attention to detail
• Desired: AS400 Computer Systems Experience
BrightSpring Health Services, and our family of brands, provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact the BrightSpring Disabilities Support Team at 1-833-773-7240 or contact us for assistance.
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