Pharmacy Billing Integrity Specialist

Classification: Contract

Duration: 12 months (high likelihood of being extended)

Location: Remote

Travel: None

Position Summary:

The Pharmacy Billing Integrity Specialist is responsible for data integrity related to pharmacy billing and charging. This position is responsible for managing files necessary to ensure data integrity of the pharmacy data base to be used as the source of truth for information related to pharmacy billing. This position requires an understanding of pharmacy workflow, operational processes, supply chain processes, medication billing practices, and supporting technologies. Individuals in this role will collaborate with corporate, division, and facility pharmacy, Corporate Regs, Revenue Integrity, and IT colleagues to execute strategies and processes to ensure accuracy of pharmacy billing. Activities are included but not limited to data maintenance to ensure integrity of pharmacy data product, requesting procedure codes through charge master application, maintenance of billing fields in the electronic health record and investigation and resolution of charge rejections identified through the Batch Report and the BatchNet application.

Major Responsibilities:

• Ensure integrity of information included in the pharmacy data product
• Complete procedure code requests in response to new/updated requests from the field
• Works to think analytically and critically to lead reporting standardization and automating efforts promoting efficiency and accuracy in data retrieval.
• Complete designated billing fields in the electronic health record, including attaching procedure codes, to ensure accurate pharmacy billing
• Investigate and resolve LP charge line billing errors
• Update pharmacy billing data in response to CMS quarterly updates
• Collaborate with leader and key stakeholders to improve workflow/processes impacting pharmacy billing
• Detail-oriented work output with highest level of reliability
• Collaborate with IT, Regs, and Revenue Integrity Team members to ensure accurate and timely pharmacy billing
• Effectively uses time and maintains focus on core responsibilities and work completion
• Performs other duties as assigned.
• Practices and adheres to the “Code of Conduct” and “Mission and Value Statement.”

Experience:

• Clinical System Knowledge (Meditech, Allscripts, Cerner, Epic, etc.)
• Charge master knowledge
• Minimum 3 years of relevant hospital pharmacy experience
• Pharmacy purchasing and billing experience

Education:

• Bachelor’s degree is preferred but not required.
• High school diploma or GED required.

Knowledge, Skills, Abilities, Behaviors:

• Adaptability – Maintaining effectiveness when experiencing major changes in work responsibilities or environment; adjusting effectively to work within new work structures, processes, requirements, or cultures.
• Building Strategic Work Relationships – Developing and using collaborative relationships to facilitate the accomplishment of work goals.
• Contributing to Team Success – Actively participating as a member of a team to move the team toward the completion of goals.
• Customer Focus – Ensuring that the customer perspective is a driving force behinds business decisions and activities; crafting and implementing service practices that meet customers’ and own organization’s needs.
• Technical / Professional Knowledge and Skills – Having achieved a satisfactory level of technical and professional skill or knowledge in position-related areas; keeping up with current developments and trends in areas of expertise.
• Work Standards – Setting high standards of performance for self and others; assuming responsibility and accountability for successfully completing assignments or tasks; self-imposing standards of excellence rather than having standards imposed.
• Effective Decision Making: Ability to make timely, informed decisions that are in the best interest of our patients, employees, providers, community and HCA.
• Communicate with Impact: Ability to deliver information in a clear, concise, and compelling manner to effectively engage others and achieve desired results.
• Drive Execution and Financial Results: Ability to commit to the success and financial wellbeing of HCA by challenging others to excel and hold themselves and others accountable for achieving results.