Pharmacist, Pharmacy Revenue Integrity

Description

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Summary:The Revenue Integrity pharmacist will join the Pharmacy Denials Management (PDM) team, which includes a three Denials Specialists and one Revenue Integrity Pharmacist. The PDM team is part of the Denials Management and Audit team in Revenue Cycle and works closely with the Pharmacy Medication Assistance Program (MAP) team and the various pharmacy clinical and operational area teams, in addition to developing and sustaining communication channels with Patient Financial Services, Hospital Billing, and Managed Care to ensure clarity, consistency and accuracy around the pharmacy charge, reimbursement and revenue cycle.

The Revenue Integrity Pharmacist will work with the PDM team to evaluate all the pharmacy claims denials, process discrepancies and identify areas for workflow improvement through routine data analysis using internal databases and key performance indicators. Best practices in pharmacy denials management will be identified and developed to ensure the department is fiscally responsible and compliant with all commercial, state and federal regulations.

The Revenue Integrity pharmacist will provide regular updates to executive and pharmacy leadership through area assessments and compliance improvement recommendations. A dashboard summary of payor denial work queues and recommendations will be presented to Pharmacy leadership and appropriate UNC Medical Center/Health Care System committees.

The Revenue Integrity Pharmacist will report directly to the Pharmacist Coordinator over Pharmacy Denials Management. The pharmacist will operate primarily in a remote work model, with physical office availability in Morrisville.

Responsibilities:

The responsibilities of the Revenue Integrity Pharmacist include, but are not limited to, the following:

• Proactively maintain specific payor denial work queues, researching payor coverage policies and appeal requirements, auditing patient account histories, and submitting required documentation to payors.
• Identify, analyze and research frequent root causes of denials and develop corrective action plans for resolution.
• Develop reporting tools that effectively measure and monitor processes throughout the denials management process
• Lead chart audits and conduct internal audits of claims and payment to assure that uncompensated patient revenues resulting from denials of patient service billings are minimized.* Provide clinical and pharmacy operational expertise to assist PDM Denials Specialists in overturning denials
• Research, respond and document insurer and patient correspondence / inquiry notes regarding coding coverage, benefits and reimbursement on patient accounts.
• Collaborate with the pharmacy pre-certification team in quality improvement initiatives.
• Develop and sustain routine communication channels with the billing, finance, accounting, and Health Information Management departments and clarity, consistency and accuracy around the pharmacy reimbursement and revenue cycle.
• Develop a performance improvement plan that will record and trend high dollar charges and denials.
• Prepare financial/regulatory/quality analysis reports for departmental leadership and staff.
• Compile, analyze, and report on the financial performance of departmental operating units.
• Maintain a current knowledge of payor and regulatory guidelines for medical insurance claims processing and reimbursement.
• Participate in departmental lean quality events.
  
• Participate in departmental and hospital committees.
  

Other information:
Education Requirements:
* PharmD or BS Pharmacy Degree
Licensure/Certification Requirements:
* Active pharmacist licensure with the NC Board of Pharmacy or obtainable before initiation of employment. Recent graduates of ACPE-accredited colleges/schools of pharmacy may fill this role while pending initial pharmacist licensure, but are subject to limitations mandated by the NC Board of Pharmacy and must obtain licensure within 6 months of orientation or sooner if required for operations.
Professional Experience Requirements:
* No prior experience required.
Knowledge/Skills/and Abilities Requirements:

• Hospital billing (CPT/HCPCS/Revenue Codes), CDM maintenance, and patient accounts
• Demonstrated understanding of medical terminology required
• Knowledge of CPT, HCPCS, and ICD10 coding
• Knowledge of patient confidentiality and HIPAA regulations
• Knowledge of medical billing and collection practices
• Understanding of Medicare and Medical Assistance regulations as they apply to job functions
• Knowledge working with electronic health records (EHR/EMR) or healthcare related computer systems
• Excellent written and verbal skills are required as well as outstanding interpersonal skills
• Efficient methods for getting work done; strong ability to prioritize workload
• Organized; sets priorities; meets deadlines
  
• Ability to work independently
  

Job Details

Legal Employer: NCHEALTH

Entity: Shared Services

Organization Unit: Pharm Revenue Integrity Progrm

Work Type: Full Time

Standard Hours Per Week: 40.00

Salary Range:$51.50 - $74.01 per hour (Hiring Range)

Pay offers are determined by experience and internal equity

Work Assignment Type: Remote

Work Schedule: Day Job

Location of Job: US:NC:Durham

Exempt From Overtime: Exempt: Yes

This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care; except that, if you are currently a UNCHCS State employee already working in a designated shared services department, you may remain a UNCHCS State employee if selected for this job.

Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.

UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email applicant.accommodations@unchealth.unc.edu if you need a reasonable accommodation to search and/or to apply for a career opportunity.