Address
Form of workSummary:
Reports to the Business Manager Pharmacy Finances consults with Manager Oncology and Sterile Compounding. The Pharmacy Revenue Integrity Specialist is an active member of the Lifespan Revenue Cycle Team. Responsible for monitoring the accuracy of medication billing including but not limited to coding and charge capture assisting with the prior authorization process and connecting patients with medication assistance programs. Maintains on-going current working knowledge of manufacturer patient assistance programs (PAP�s) co-pay assistance programs and insurance reimbursement. Manages patient medication requests in real time and updates the medication assistance program database. Works to minimize patient out-of-pocket expense and maximize the use of medication assistance programs and insurance reimbursement. Participates in continuous quality improvement activities and functions in a manner that contributes to a highly effective multidisciplinary work group.
Responsibilities:
PRINCIPAL DUTIES AND RESPONSIBILITIES:
Is responsible for knowing and acting in accordance with the principles of the Lifespan Corporate Compliance Program and Code of Conduct.
In addition to position specific responsibilities the Pharmacy Revenue Integrity Specialist shall be responsible for the following:
Review and verify new charge description master (CDM) drug builds to ensure the accuracy of all fields including but not limited to item description billing unit Health Care Common Procedure Coding Systems (HCPCS) code J code acquisition cost and charge price.
Audit charge description master (CDM) periodically to verify the accuracy of existing data fields make modifications if indicated.
Serve as the pharmacy point of contact for medication billing questions.
Serve as active member of Lifespan�s Revenue Cycle Team and Revenue Integrity Team.
Provide pharmacy expertise to assist the Lifespan Revenue Cycle Team with prior authorizations drug charges and denials review.
Communicate effectively and professionally with patients health care providers insurance companies manufacturers and Revenue Cycle and Revenue Integrity Teams.
Facilitate the transition to preferred medications including biosimilars from eligibility prior authorization and billing perspectives.
Identify and initiate systemic processes designed to help prevent inaccurate charging coding and billing.
Develop a process to identify patients with outstanding balances. Determine eligibility for a manufacturer PAP or a copay assistance program. Identify alternate billing options if any.
Enroll eligible patients in PAP or copay assistance program. Initiate alternate billing options if any.
Analyze and review charge reports and Medication Administration Record (MAR) actions to ensure accurate reimbursement/billing.
Audit white bagged medication charges to ensure they are appropriately charged with a $0.10 charge.
Document audit and review activities maintain complete and accurate records.
Provide input on the development of policies and procedures related to revenue cycle.
Maintain knowledge of and expertise in leading edge developments in medication billing and revenue cycle by participation in ongoing independent study education-related professional activities and affiliations.
Identify and communicate quality and process improvement opportunities regarding third party billing and Pharmacy Revenue cycle operations
Participate in the development of tools and standards to establish and improve documentation of processes.
Other information:
BASIC KNOWLEDGE:
High school graduate or equivalent degree. Completion of one to two years of college preferred.
Maintains current unrestricted Rhode Island Pharmacy Technician licensure and National Pharmacy Technician Certification (CPhT) through Pharmacy Technician Certification Board (PTCB).
Billing and Reimbursement Certification through PTCB preferred.
EXPERIENCE:
Minimum of one-year pharmacy technician experience as a CPhT.
Effective problem solving and critical thinking skills.
Experience producing and analyzing data driven reports preferred.
Ability to communicate and present information effectively in both oral and written form with all levels of hospital personnel and all patient groups.
Strong customer service presence.
Must possess solid computer skills including Microsoft Office Suite as well as email and calendar applications. Must be comfortable in using internet web applications and multiple pharmacy and system-wide applications.
WORK ENVIRONMENT AND PHYSICAL REQUIREMENTS:
Requires ability to stay focused in a fast paced ever changing environment.
May require extended periods of time spent standing and walking.
Requires the visual acuity and manual dexterity necessary to operate a computer and using a typical keyboard and computer mouse to navigate screens on a computer monitor.
INDEPENDENT ACTION:
Performs independently within department policies and practices.
Refers specific complex problems to supervisor where clarification of departmental policies and procedures may be required.
SUPERVISORY RESPONSIBILITY:
None.
Lifespan is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status. Lifespan is a VEVRAA Federal Contractor.
Location: Rhode Island Hospital USA:RI:Providence
Work Type: Full Time
Shift: Shift 1
Union: Non-Union
