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Company

Jobility Talent Solutions · 1 day ago

Billing Compliance Specialist (Pharmacy)

United States

Contract

Remote

Mid Level

$35/hr - $38/hr

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Information TechnologySoftware

Hiring Manager

Barnabas Khana

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Responsibilities

Review Client’s compliance/risk management tool daily: analyze and report any pharmacy related coding changes; and recommend appropriate policy and procedure changes to the management team.

In collaboration with Patient Accounts, audit pharmacy charge records and make charge/credit adjustments where necessary.

Represents the Pharmacy Division in internal and external audits related to pharmacy billing; implements policy and procedure changes that result.

Performs routine audits and quality assurance reviews of pharmaceutical charge activities

Identify potential areas of compliance vulnerability and risk; Develop and make recommendations for corrective action.;

Provide general guidance and advice to pharmacy leadership on compliance issues and resolution.

Audit retail medication reversals and re bills for compliance accuracy.

Responsible for the maintenance and update of all Pharmacy policies and procedures related to pharmacy billing compliance.

Responsible for ensuring timely and accurate billing via the automated interface between our clinical pharmacy and patient accounts/finance systems.

Review billing exception reports and reasonability bases lines to ensure appropriate billing.

Provide direct support to Pharmacy, Patient Accounts or other staff for pharmacy billing inquiries and trouble calls.

Manage a bi-annual update of pharmaceutical AWP prices, ensuring coordination between the Pharmacy clinical system and our patient accounts and finance systems.

Conduct a quarterly analysis of our pharmaceutical prices by comparing average acquisition costs to average wholesale prices; determine if any price adjustments are appropriate; and implement adjustments at the direction of Pharmacy management.

Review discrepancies between the date of administration and the date of the pharmacy charge; perform chart reviews to determine the appropriate date of service; make charge corrections where necessary; and recommend order corrections to pharmacy staff.

Review pharmacy charge related IDB quality reports, perform chart reviews to determine if corrective action is required.

Manage pharmacy medication pump billing and tracking program.

Implement a pharmacy division billing compliance education and training program.

Respond to Patient Account inquiries regarding retail prescriptions; evaluate, identify and address billing discrepancies; escalate as needed to pharmacy leadership.

Execute a monthly reconciliation of expected and actual retail prescription reimbursements from prescription plan payers to ensure that client is receiving all due payments.

Assist pharmacy informatics staff in all aspects of routine internal and external compliance audits.

Issue charges or credits as directed by the manager of Pharmacy Billing to address inappropriate medication charges.

Participate in system testing projects, especially those related to medication billing compliance.

Identifies gaps in existing reports, and designs new ones using report writing tools and software, such as SQL.

Performs any other project at the direction of the manager of Pharmacy Billing.

Completes projects and/or activities, which meet departmental criteria to maintain and advance professional competency based on divisional guidelines.

Attends/documents attendance of Pharmacy sponsored meetings, i.e. continuing education programs, grand rounds, and general staff meetings when coverage is available and workload permits.

Participates in any relevant/related training sessions at the direction of the Manager of Pharmacy Billing.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Drug codingData analyticsEPIC WillowBilling complianceSQL Report WritingQuality assurancePharmacy policiesPharmaceutical pricingCompliance auditsProject management

Required

Drug coding, data analytics, knowledge of EPIC Willow charge capture, and quick learner.

Review Client’s compliance/risk management tool daily: analyze and report any pharmacy related coding changes; and recommend appropriate policy and procedure changes to the management team.

In collaboration with Patient Accounts, audit pharmacy charge records and make charge/credit adjustments where necessary.

Represents the Pharmacy Division in internal and external audits related to pharmacy billing; implements policy and procedure changes that result.

Performs routine audits and quality assurance reviews of pharmaceutical charge activities.

Identify potential areas of compliance vulnerability and risk; Develop and make recommendations for corrective action.