Must have a Pharmacy Technician National Certification such as PTCB or NHA AND TN Pharmacy Tech License to qualify A Brief Overview Responsible for preventing and correcting issues related to billing, revenue and Charge Description Master (CDM) to ensure appropriate capture and reporting of revenue and maintain the integrity of systems in compliance with regulatory guidelines. Serves as liaison between pharmacy, finance and ancillary departments regarding revenue management initiatives and issues.
Performs financial review and analysis to assist in resolving billing edits that are holding patient claims from billing, by reviewing medical records and other applicable documentation. * Interact with ancillary departments to obtain additional information needed to properly bill account based on medical record. * Identify charging, coding, or clinical documentation issues and work with ancillary departments to resolve issues and notify appropriate leadership. * Review denial trends for documentation or charging issue opportunities. * Reviews billing compliance correspondence and adheres to all guidelines. * Performs assigned audits by researching documentation, analyzing information, and makes recommendations to improve flow of claim and enters all corrections into systems. * Serves as liaison to include regular reviews of CPT codes, revenue codes, review of monthly standard CDM error report and communicating with Ancillary Departments to resolve issues. * Coordinate educational in-services to Inpatient Pharmacy staff and Ancillary staff related to charging and billing issues.
Assesses the accuracy of all medication charges * Understands and able to perform the balancing of charge posting from clinical and ancillary systems, checking per-edits from charge keying, working with Charge Description Master errors, rejects, late charges and other related duties of data control. * Evaluates current charging and coding structures and processes in clinical/ancillary departments to ensure appropriate capture and reporting of revenue and compliance with government and third party payor requirements. * Analyzes changes to coding and billing rules and regulations by utilizing appropriate reference materials, internet sources, seminars and publications. * Provides guidance, communication and education on correct charge capture, coding and billing processes to finance and ancillary staff.
Oversees the Pharmacy Charge Description Master (CDM) and monitor synchronization of item masters. Coordinate and communicate medication revisions (Add/delete/update) information in the CDM and other profiles and tables in accordance with Regional One Health and governmental policies and procedures. Understands and interprets Regional One Health, State and Federal guidelines and policies for billing technical charges related to medication charges.
Utilizes operational and systems knowledge to communicate persuasively with departments to ensure correct interpretation of and compliance with guidelines. Utilizes investigational skills to determine when to contact other resources when dealing with unfamiliar clinical or operational situations. Works with Finance for all functions of the CDM information system and tool related to medications * Become expert in the use of the tools. * Update item linkages as frequently as data is refreshed with the tools. * Understands the workflow within the Charge Master so that CDM’s are maintained timely and such that all appropriate reviews are document. * Research charging regulations as requested or required. * Provides technical direction and assistance to users to provide continuous operations of system.
Analyzes, review and present financial information and summary reports to management. * Prepares/analyzes financial models of current operations. * Utilizes computer to enter and format data, generate statistics, computations, tables, or charts. * Generates comprehensive reports to support management decision-making. * Coordinates the gathering of specific information from Pharmacy, Accounting, Patient Financial Services and other departments involved in the development of financial reports/analysis. * Maintains reports, records and files for administrative and compliance purposes.
Participates in all ancillary and information system development (new/upgrade) and testing. Collaborates with the Informatics Lead Pharmacist to coordinate system activities. * Ensures that requirements for the generation of a compliant bill are gathered during the electronic processing of data. * Assist with the resolution of issues through an understanding of where data originates and how it is processed and ultimately utilized. * Assists with maintenance of information system master files, profiles and tables. * Utilizes understanding of clinical/financial system processing/flow to implement department requested changes.
Participates in process improvement activities. * Responds to problems/opportunities to improve revenue integrity process utilizing creative problem-solving skills. * Performs leadership role in intermediate level process improvement projects. * Supports and is involved in the organization’s Performance Improvement initiatives. * Trains operations staff on new processes, guidelines or regulations. * Utilizes a broad knowledge of Regional One Health systems Develops and presents educational materials to staff as needed with regard to industry trends, results from data gathered through month end reports, revenue integrity reports, and other billing and revenue areas.
Provides administrative support for special projects and studies; collects and compiles data, performs statistical analysis and follows-up as requested or needed. Collaborates with Compliance, Finance, Patient Accounts, Information Technology, Managed Care, Internal Audit and other Revenue and Finance departments on revenue management initiatives. Qualifications Associate's Degree in Business Administration with emphasis in Finance, Accounting, HealthCare Administration/Management or Economics.
Required or Bachelor's Degree in Business Administration with emphasis in Finance, Accounting, HealthCare Administration/Management or Economics. Required Certified Pharmacy Technician Upon Hire Required and State Board of Tennessee Board of Pharmacy Certified Pharmacy Technician License Upon Hire Required Minimum 2 years experience in a related area to include pharmacy operations, computer/electronic worksheet skills, financial analysis application skills, database development, report generation and financial documents including accounts receivable, billing and computer graphics.
Combination of education and directly related work experience will be considered. Required Physical Demands Standing - Occasionally Walking - Occasionally Sitting - Constantly Lifting - Rarely Carrying - Rarely Pushing - Rarely Pulling - Rarely Climbing - Rarely Balancing - Rarely Stooping - Rarely Kneeling - Rarely Crouching - Rarely Crawling - Rarely Reaching - Rarely Handling - Occasionally Grasping - Occasionally Feeling - Rarely Talking - Constantly Hearing - Constantly Repetitive Motions - Frequently Eye/Hand/Foot Coordination - Frequently Regional One Health is an equal opportunity employer.
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