Hospital Pharmacy Revenue Analyst (Program Technician 1)

Department Overview

The Clinical Pharmacy Revenue Analyst works independently performing specialized and detailed review of

the entire medication use cycle. This includes reviewing medical charts, documentations and medication use

workflow to determine conformity for documentation and billing compliance in support of the complex, ever

changing and expanding Pharmacy Service Lines.

 

This position uses pharmacy clinical knowledge to research, interpret and analyze pharmacy workflow. This in

turn will provide technical support in the design, implementation and ongoing monitoring of pharmaceutical

charge processes in order to maintain compliance standard coding and billing quantity.

 

Use in-depth knowledge on Pharmacy Willow in Epic in order to identify difference between workflow and

system issues as they arise. Timely and accurate review and submission of pharmacy charges. Triage of

incoming inquires for all pharmacy service lines. Collaborate with Pharmacist and Pharmacy Operations

Management team in order to adapt workflow to properly capture patient revenue accurately when the system

is unable to support the function. Train and cross-train team members. Create new and maintain policies and

procedures.

 

This is of the first of the two levels in this job class.

Function/Duties of Position

Use pharmacy hospital clinical knowledge to perform detail review and analysis of pharmacy dispense, verification, administration documentation, waste documentation and coding to ensure pharmacy billing compliance standards are met. 

• Verify medication dosing unit of measure calculation based on specific National Drug Code (NDC) and for units administered to the patients 
• Ensure current up to date pricing by validating Epic applied pricing is consistent with external source, when inconsistency exist use experience and judgement to propose resolution
• Review Healthcare Common Procedure Coding Systems (HCPCS) coding and Medicare billing quantity are appropriate to ensure maximize reimbursement and prevent payer denial 
• Analyze and validate accuracy of JW Waste Modifier documentation and perform manual calculation and charge when necessary
• Trouble shoot; problem solve, communicate and collaborate deficiency
• Maintain multiple follow-ups and work towards resolution with Nursing, Providers and Pharmacy Operations on deficiency to support billing compliance
• Review false positive reports for deficiency and identify trends, resolve issues and plan remediation plan as necessary
• Analyze and interpret paper medication documentations for non-Epic system charge and perform manual charge capture aka bulk charging in Epic Willow 

Provide technical support in the design, implementation and ongoing monitoring of pharmaceutical charges across multiple pharmacy systems. Ensure pharmacy charge methods are in compliance with regulatory requirements.

• Work to continuously evaluate pharmacy systems that are used for charge capture and supporting documentation
• Use the Omnicell Automated Dispense Cabinet report to assess medication utilization by hospital units
• Utilize Workflow Rx system to remotely access Omnicell Carousel Medication Cabinet in order to view inventory and pharmacy dispense tracking
• Run EPIC workbench, Omni center Firefox, Bobj reports to review details

Other duties as assigned Other Duties

Required Qualifications

• Three years of experience administering or coordinating parts or subsets of a project or program.

• A bachelor’s degree in business administration, Management, Public Administration, or a field directly related to the position will substitute for two years of the required experience.

• Note: preference in hiring may be given in a special area specific to the position opening. 

Job Related Knowledge, Skills and Abilities (Competencies):

• Related experience in a pharmacy technician role in a hospital that requires accurately, efficiently and effectively meet the performance standards for Triage, Decentralized and IV Room responsibilities. 
• Proficiency with Epic, Microsoft Outlook, Excel, PowerPoint and Word 
• Organized task and follow-up items 
• Ability to read and understand medical related terms
• Ability to perform basic pharmaceutical mathematics calculations
• Ability to effectively work both independently and in a team environment; effective organizational abilities, oral and written communication skills, and interpersonal skills; ability to operate and communicate effectively while meeting multiple deadlines and completing projects simultaneously; ability to interact in a posit