Pharmacy Billing Specialist

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Position Details

Department: PCH-MAIN | Pharmacy Admin
Location: Phoenix
Shift: Mon-Fri, Days, 8am-5pm
Category: Pharmacy
Posting #: 952684
Employee Type: Full-Time

Position Summary

Posting Note: This is an onsite, full time, hourly position. This position works within the Pharmacy Revenue Cycle Team to support all assigned pharmacy billing functions. Duties include manual review of identified billing claims through fatal edit reports, reviewing and resolving billing tickets, auditing charge master for appropriateness in built charges, and quarterly reviewing CMS changes in billing requirements. This position will also help develop and maintain SOPs to ensure pharmacy billing functions are optimized to changes in billing requirements. This position reports to the Director of Pharmacy Business Operations, and works closely with Revenue Cycle, and the 340B Team. Phoenix Children's has a great work culture, and we are looking for an individual with an emphasis on cultural fit, ability to continually learn, and has a “builder” mindset to develop and maintain pharmacy revenue cycle functions.

The Pharmacy Billing Specialist will serve as the point of contact for all medication billing related activities throughout the inpatient and ambulatory sites of care. Scope of work for this role may include the review of medication charges and revenues, research incomplete information related to billing errors/denials, audit existing medication charges, and develop/maintain billing workflows. This individual also ensures new medication billing rules and regulatory changes (CMS and payors) are assessed for compliance, timely processes invoices, and assists in the development of policies and procedures. The Pharmacy Billing Specialist primarily collaborates with Revenue Cycle teams and directly reports to the Director of Pharmacy Business Operations.

Position Duties

  • I. Serve as the point-of-contact for pharmacy billing; actively reviews and resolves billing issues related to charge codes, errors, exceptions, denials, and workflows; collaborates with and provides guidance primarily to Revenue Cycle teams; proactively escalates billing issues or critical insights to Pharmacy leadership and Revenue Cycle teams.
    a. Resolve admit/discharge related medication charge errors
    b. Perform Medicare edits in PFM (finance system) in conjunction with IT Pharmacists
    c. Process credits for doses returned to pharmacy
    d. Manages cost transfers to other departments each month in a timely manner
    e. Completes Medicare rebills where they arise in pharmacy and external department charges and systems
  • II. Review and keep updated existing pharmacy billing processes/workflows and develop new standard operating procedures (SOPs) in conjunction with Revenue Cycle, IT, and Pharmacy leadership as related to the following systems.
    a. Automated dispensing systems (ie Omnicell)
    b. Pharmacy IT and Clinical systems (SRx/SCM) Allscripts
    c. Patient financial systems (PFM) Allscripts
    d. Manual charge sheets and department databases
    e. Patient access system (SAM) Allscripts
  • III. Perform ongoing audits and certify all built medication charges are compliant with departmental, Medicare, Medicaid, Commercial Payors, and State policies, billing rules, and guidelines.
  • IV. Receive, forward for review, and process invoices in conjunction with Accounts Payable team.
  • V. Maintains professional and technical competency in all aspects of pharmacy billing through training (CEs, conferences, courses, webinars, degrees, and certifications).
  • VI. Serves on the Pharmacy Business Operations, Office of Business Integrity and other ad hoc committee meetings related to medication and pharmacy charge and billing integrity.
  • Performs miscellaneous job related duties as requested.

Phoenix Children's Mission, Vision, & Values

Mission

To advance hope, healing and the best healthcare for children and their families

Vision

Phoenix Children's will be the leading pediatric health system in the Southwest, nationally recognized for exceptional care, innovative research and advanced medical education.

We realize this vision by:

  • Offering the most comprehensive care across ages, communities and specialties
  • Investing in innovative research, including emerging treatments, tools and technologies
  • Advancing education and training to shape the next generation of clinical leaders
  • Advocating for the health and well-being of children and families
Values
  • We place children and families at the center of all we do
  • We deliver exceptional care, every day and in every way
  • We collaborate with colleagues, partners and communities to amplify our impact
  • We set the standards of pediatric healthcare today, and innovate for the future
  • We are accountable for making the highest quality care accessible and affordable

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Position Qualifications

Please review the following qualifications and specify whether you meet each of the requirements listed.

Education

 Do you meet this requirement or have the ability to obtain it
within the timeframe listed in the requirement?
1. High school diploma or equivalent
Required
2. Associates or Bachelors degree in a related field or equivalent
Preferred

Experience

 Do you meet this requirement or have the ability to obtain it
within the timeframe listed in the requirement?
1. 1.Minimum of one (1) year of experience/exposure to pharmacy billing, medical billing, or equivalent Required
Required
2. 2.At minimum a moderate competency in Excel
Required
3. 3.Knowledge of HCPCS codes, modifiers, ICD-10/CPT codes, and government/commercial payor guidelines
Preferred
4. 4.Knowledge of reimbursement, medical terminology, and HIPAA privacy laws
Preferred
5. 5.Two (2) years of acute health care environment or equivalent experience
Preferred
6. 6.Advanced knowledge and experience in pharmacy coding, billing, and invoicing
Preferred
7. 7.Knowledge of professional fee billing
Preferred
8. 8.Allscripts EHR, and Image Express experience
Preferred

Special Skills

 Do you meet this requirement or have the ability to obtain it
within the timeframe listed in the requirement?
1. 1.Proficient with data and document programs (i.e. Microsoft Word, Excel or Access and/or Pivot Tables experience)
Required
2. 2.General knowledge and exposure to a 340B Program and drug purchasing programs
Preferred
3. 3.Auditing experience
Preferred

Additional Requirements

 Do you meet this requirement or have the ability to obtain it
within the timeframe listed in the requirement?
1. 1.Current license and registered as a Pharmacy Technician in Arizona (CPhT Certification from PTCB)
Preferred
2. 2.Pharmacy Billing and Reimbursement Certificate from PTCB
Preferred
3. 3.CPhT-Adv Certification from PTCB
Preferred
4. 4.Professional Coding Certification (CPC)
Preferred

Physical Requirements & Occupational Exposure/Risk Potential

1. Physical Requirement - Climbing - Frequently
2. Physical Requirement - Feeling (sensing textures and temperatures) - Frequently
3. Physical Requirement - Fine Motor Skills (pinching, gripping, etc) - Constantly
4. Physical Requirement - Hearing - Constantly
5. Physical Requirement - Pushing/pulling - Constantly
6. Physical Requirement - Reaching - Constantly
7. Physical Requirement - Sitting - Frequently
8. Physical Requirement - Standing - Constantly
9. Physical Requirement - Stooping/crouching/kneeling/crawling - Frequently
10. Physical Requirement - Talking - Constantly
11. Physical Requirement - Tasting/smelling - Frequently
12. Physical Requirement - Walking - Constantly
13. Physical Requirement - Near Vision - Constantly
14. Physical Requirement - Far Vision - Constantly
15. Physical Requirement - Color Discrimination - Frequently
16. Physical Requirement - Use of keyboard, mouse and/or computer equipment - Constantly
17. Physical Requirement - Lift up to 35 pounds without assistance - Frequently
18. Physical Requirement - Lift more than 35 pounds without assistance - Frequently
19. Occupational Exposure/Risk Potential - Inside office environment - Applicable
20. Occupational Exposure/Risk Potential - Outdoor weather conditions - Applicable
21. Occupational Exposure/Risk Potential - Extreme temperatures - Applicable
22. Occupational Exposure/Risk Potential - Confined areas - Applicable
23. Occupational Exposure/Risk Potential - High places - Applicable
24. Occupational Exposure/Risk Potential - Airborne communicable diseases - Applicable
25. Occupational Exposure/Risk Potential - Bloodborne pathogens or bodily fluid - Applicable
26. Occupational Exposure/Risk Potential - Fumes or airborne particles - Applicable
27. Occupational Exposure/Risk Potential - Hazardous materials exposure - Applicable
28. Occupational Exposure/Risk Potential - Radiation exposure - Applicable
29. Occupational Exposure/Risk Potential - Toxic or caustic chemicals - Applicable
I have reviewed the qualifications, physical requirements and occupational exposure/risk potential for this position and wish to apply