Pharmacy Charge Specialist
Description
Summary:
The Pharmacy Charge Specialist position is responsible for providing analytical support in all areas of system pharmacy-related charges and revenue. Responsible for the oversight and maintenance of the system Pharmacy CDM and related ancillary systems content according to government and third party payer regulations and guidelines. Monitors regulatory changes and payer requirements. Works closely with all revenue-producing areas to ensure accurate and compliant pharmacy charge capture.
Responsibilities:
Responsibilities
Responsibilities & Qualifications include:
Monitors and responds to Nuvance Health system-wide billing issues identified in the Cerner Patient Accounting application
Daily monitoring of the system EHR health information technology Pending Queue (Pending charges comprise medication orders that are administered differently than ordered, as well as intermittent and continuous orders that are administered without having products assigned).
Investigates and corrects excessive billing unit claims
Reviews and corrects all rejected charges that occur
Monitors and reviews the daily JW modifier approval report. If items are identified to be rejected from the report, then this person will be responsible for the appropriate crediting and rebilling of the medication in question
Coordinates CDM maintenance with the appropriate Revenue Integrity analyst. This would be in conjunction with the formulary review, leveraging appropriate technology platform
Conduct annual review of reimbursement codes (JCODES) and update the formulary accordingly
Keeps current with Pharmacy Billing Regulations for compliance
Assist in investigating and responding to Billing Audits
Supports data integrity through interaction with financial and outcomes systems and auditing verification
Participates and lead committees, work groups, process improvement efforts, and educational initiatives to improve pharmacy revenue integrity and pharmacy billing cycle
Conforms to hospital standards of performance and conduct, including those pertaining to patient rights, so that the best possible customer service and patient care may be provided
Other initiatives and tasks required per leadership team relevant to position
Other Information:
Working Conditions:
Manual: Some manual skills/motor coord & finger dexterity
Occupational: Little or no potential for occupational risk
Physical Effort: Sedentary/light effort. May exert up to 10 lbs. force
Physical Environment:
Company: Nuvance Health
Org Unit: 1937
Department: Pharmacy Corp
Exempt: No
Salary Range: $21.49 - $41.73 Hourly