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Pharmacy Charge Analyst

Company Name:
LPC Healthcare Recruiting Solutions, Inc.
Pharmacy Charge Integrity and Business Specialist
We are seeking a Pharmacy Charge Integrity and Business Specialist for our magnet status hospital.
Job summary
This position will serve as a liaison between Finance, Revenue Integrity, IT, and Pharmacy departments to implement and standardize compliant and optimized maintenance and audit functions of pharmacy revenue and business processes.
The Pharmacy Charge Integrity and Business Specialist is also responsible for completing financial analyses of any proposed changes to determine charge and revenue implications related to the pharmacy charge description master (PCDM) maintenance; communicating findings to management and overseeing the implementation of approved recommendations to ensure appropriate revenue capture.
Job responsibilities:
As appropriate, ensure that any recommended changes to drug list or PCDM are provided to IT for implementation into the hospital's clinical and financial systems
Perform quality reviews in order to ensure that PCDM additions, inactivations, changes and/or revisions were accurately completed in the hospitals clinical and financial systems
Perform quality audits as assigned by reviewing claims to ensure that all HCPCS/CPT codes, billable units, multipliers, modifiers, and indicators are transferring appropriately
Develop analytical tools to audit and analyze hospital pharmacy data elements
Develop policies and procedures for coding, billing, and maintenance of the PCDM
Work with EPIC and Finance to implement revenue neutral pharmacy charge formulas using a best practice and industry standard charge base (i.e. (MAC, WAC, AWP, actual acquisition)
Work closely with various departments post-standard formulary mark-up implementation to complete charge audits that verify services provided and total billed charges are compliant with the standard
Analyze and verify individual patient charges for accuracy and completeness as requested
Evaluate charge changes for impact on revenue and report findings to appropriate parties
Serves as primary resource to Patient Financial Services staff for reporting problems and denials on individual claims. Researches coding issues and recommends solution to account representative. Identifies source of problem and implements corrective action to insure that PCDM is updated to prevent future rejections/denials and to insure accurate and expedient reimbursement.
Completes routine audits and transaction testing to insure regulatory billing compliance and to support departmental compliance initiatives.

Minimum years experience required and preferred
Significant previous experience working with the Pharmacy CDM or related revenue cycle experience, 3 years minimum
Minimum education required and preferred
Bachelor's degree in a relevant field preferred (i.e. BS Pharm or PharmD.). In lieu of degree, 8-10 years experience with the pharmacy CDM or related revenue cycle.
Qualified Pharmacy Technicians will be considered
Licensures/special skills
Registered Pharmacist/PharmD
Certified Pharmacy Technician
EPIC certification - preferred
Advanced experience with Microsoft Excel

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