Pharmacy Charge Analyst - Specialty Pharmacy
Billings Clinic

Billings, Montana

Posted in Health and Safety
9 days ago


This job has expired.

Job Info


Pharmacy Charge Analyst - Specialty Pharmacy

SPECIALTY PHARMACY

Non-Exempt
req1009

Shift:  Day

Employment Status:  Full-Time (.75 or greater)

Hours per Pay Period:  1.00 = 80 hours

Starting Wage DOE:  $17.71 - $24.13


Serves as the primary focal point and charge analyst for all billing related activities in the Pharmacy Department. The position is responsible for researching and remaining informed on pharmacy compliance regulations, laws, and guidelines as they relate to billing. The Pharmacy Charge Analyst works closely with Pharmacy Leadership and related internal departments such as Patient Financial Services and Accounting to ensure billing guidelines are adhered to and high-risk areas are identified and addressed. Position is responsible to review, analyze, and interpret regulations and standards for appropriate charging, to ensure adherence to third party payer regulations and standards, to monitor reimbursement for medications administered and place charge-process standards into practice. Provides billing and reimbursement training and education to pharmacists and technicians, communicates charging and documentation requirements, and conducts regular audits of charge practices and reimbursement throughout the organization. Provides documentation to Department Managers; makes recommendations, when appropriate, and/or revises procedures as needed.

 

Essential Job Functions

* Supports and models behaviors consistent with Billings Clinic's mission, vision, values, code of business conduct and service expectations. Meets all mandatory organizational and departmental requirements. Maintains competency in all organizational, departmental and outside agency standards as it relates to the environment, employee, patient safety or job performance.
* Develops and implements a system to solicit, evaluate, and respond to complaints and concerns relating to medication charges or billing issues from any Billings Clinic department, person, or employee. Investigates and acts on matters related to billing/charges, responding to inquiries for clarification or verification of charges and/or billing processes.
* Participates in the regular review and audit of medication charges.
* Audits patient's medical records versus the dispensing and/or administration record to ensure all medications are billed in accordance with Billings Clinic charging policies. Communicates audit results and makes recommendations to Pharmacy Leadership. Revises and/or reinforces procedures when indicated, to obtain the desired result.
* Researches, analyzes and resolves situations in which inappropriate payment (low or none) has been received from payers. Challenges inaccurate payments made when posting "explanation of benefits" and remittance advises to maximize reimbursement. Corrects and reprocesses bills, if appropriate.
* Assists in the production of monitoring reports from the charge/ billing systems across the organization. Assumes ownership role in responsibility for success of analytics and ad hoc reporting.
* Charges interdepartmental medications, assigns the natural classes, and appropriates charges to the correct journal account. Reviews, revises, and continuously improves cost accounting processes between departments. Provides department managers with current usage and cost reports of stocked medications.
* Acts as a resource and liaison for external audits and communications related to compliance issues with various departments such as: Decision Support, Information Services, Patient Financial Services, Compliance, and Risk Management.
* Manual pricing of nonformulary medications. Includes the review and research associated with the pricing and utilization of non-formulary medications.
* Responsible for the reporting and analysis of all retail pharmacy performance and relaying that information to accounting for proper recording of revenues. Presents findings to Pharmacy Leadership on a regular basis.
* Performs other duties as assigned or needed to meet the needs of the department/organization.

Minimum Years of Experience:

Two years of work experience with patient accounting, auditing, cost accounting, and/or ledger billing,
Two years experience in a multi-specialty clinic working with ICD-10, CPT-4/HCPCS coding, preferred.

Within 1 year of hire obtain Pharmacy Technician certification.

Other Qualifications:

* Previous experience with Excel, Word, Cerner EMR, Cerner Rev Cycle, AS400, Lawson, preferred
* Demonstrated ability to understand and develop complex spreadsheets
* Or an equivalent combination of education and experience relating to the above tasks, knowledge, skills and abilities will be considered.

 

Billings Clinic is Montana's largest health system serving Montana, Wyoming and the western Dakotas. A not-for-profit organization led by a physician CEO, the health system is governed by a board of community members, nurses and physicians. Billings Clinic includes an integrated multi-specialty group practice, tertiary care hospital and trauma center, based in Billings, Montana. Learn more at www.billingsclinic.com/aboutus

Billings Clinic is committed to the principles of Equal Employment Opportunity. All policies and processes are designed toward achieving fair and equitable treatment of all employees and job applicants. Employees are encouraged to discuss any concerns they have in this regard with their immediate supervisor and/or the Vice President People Resources. All employees and job applicants will be provided the same treatment in all aspects of the employment relationship, regardless of race, color, creed, religion, national origin, gender, gender identity, sexual orientation, age, marital status, genetic information or disability.


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