Pharmacy Business Analyst - FT - Days - Memorial Specialty Pharmacy

Location:

Miramar, Florida

At Memorial Healthcare System (MHS), our ever-growing pharmacy career options present unlimited opportunities to individuals passionate about advancing pharmacy practice. As a nationally recognized and respected leader for providing “A-rated” patient care and safety, MHS prides itself on being able to grow and adapt to the rapidly evolving needs of our community and healthcare industry.

Summary:

Reviews, analyzes, and coordinates financial transactions and activities for the department. Ensures compliance with billing requirements and auditing for pharmacy and medical billing claims, payment application, claim audits, and reconciliation. Coordinates monthly financial reporting and auditing and assist with annual budgeting process.

Responsibilities:

Prepares financial and operational reports as needed.Ensure compliance and conducts audits of Pharmacy NCPDP claims and Medical Billing. Provides expert knowledge of billing for a variety of self pay and health insurance plans, including Medicare, Managed Care, and private insurance.Refers accounts for patient assistance and drug replacement when needed.Assist in maintaining records needed for business needs, including NCPDP, and license updates, HIN, etc.Investigates and responds to third party audits to minimize third party chargebacks. When needed reconciles charge backs as a results of payer audits.Audits and analyzes reimbursement opportunities for patient and third party accounts. Audits and reconciles accounts receivables and payments from payers.Reviews, addresses and reconciles profitability opportunities by reviewing appropriateness of payments vs. cost of goods.Ensures pharmacy billing compliance with current regulatory guidelines, insurance billing requirements, state and federal laws and regulations ( Including bit not limited to Medicare part B and D claims). Develops process to ensure collection when applicable.

Competencies:

ACCOUNTABILITY, ACCOUNTING - FINANCIAL STATEMENTS/BUDGETS, ACCOUNTING - JOURNAL ENTRIES, ACCOUNTING - VARIANCE ANALYSIS, ANALYSIS AND DECISION MAKING, CUSTOMER SERVICE, DEVELOPS RELATIONSHIPS, EFFECTIVE COMMUNICATION, FINANCIAL ANALYSIS, PROBLEM SOLVING, RESPONDING TO CHANGE, STANDARDS OF BEHAVIOR

Education and Certification Requirements:

High School Diploma or Equivalent (Required)Certified Coding Associate (CCA) - American Health Information Management Association (AHIMA), Registered Pharmacy Technician (RPT LICENSE) - State of Florida (FL)

Additional Job Information:

Complexity of Work: Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action. Required Work Experience: Five (5) years of experience in retail, specialty pharmacy or home infusion pharmacy medical/pharmacy billing. Other Information: Additional Credential Info: Medical billing and coding certification. Licensed/Registered in the State of Florida.

Working Conditions and Physical Requirements:

•  Bending and Stooping = 60%
•  Climbing = 60%
•  Keyboard Entry = 60%
•  Kneeling = 60%
•  Lifting/Carrying Patients 35 Pounds or Greater = 20%
•  Lifting or Carrying 0 - 25 lbs Non-Patient = 60%
•  Lifting or Carrying 2501 lbs - 75 lbs Non-Patient = 60%
•  Lifting or Carrying > 75 lbs Non-Patient = 20%
•  Pushing or Pulling 0 - 25 lbs Non-Patient = 60%
•  Pushing or Pulling 26 - 75 lbs Non-Patient = 60%
•  Pushing or Pulling > 75 lbs Non-Patient = 20%
•  Reaching = 60%
•  Repetitive Movement Foot/Leg = 20%
•  Repetitive Movement Hand/Arm = 20%
•  Running = 0%
•  Sitting = 60%
•  Squatting = 60%
•  Standing = 60%
•  Walking = 60%
•  Audible Speech = 60%
•  Hearing Acuity = 60%
•  Smelling Acuity = 0%
•  Taste Discrimination = 0%
•  Depth Perception = 60%
•  Distinguish Color = 60%
•  Seeing - Far = 40%
•  Seeing - Near = 60%
•  Bio hazardous Waste = 20%
•  Biological Hazards - Respiratory = 20%
•  Biological Hazards - Skin or Ingestion = 20%
•  Blood and/or Bodily Fluids = 20%
•  Communicable Diseases and/or Pathogens = 20%
•  Asbestos = 0%
•  Cytotoxic Chemicals = 0%
•  Dust = 60%
•  Gas/Vapors/Fumes = 20%
•  Hazardous Chemicals = 20%
•  Hazardous Medication = 0%
•  Latex = 0%
•  Computer Monitor = 60%
•  Domestic Animals = 0%
•  Extreme Heat/Cold = 0%
•  Fire Risk = 20%
•  Hazardous Noise = 20%
•  Heating Devices = 0%
•  Hypoxia = 0%
•  L