Posted:
8/21/2024, 5:00:00 PM
Location(s):
Oregon, United States ⋅ Bend, Oregon, United States
Experience Level(s):
Junior ⋅ Mid Level ⋅ Senior
Field(s):
Medical, Clinical & Veterinary
ST. CHARLES HEALTH SYSTEM
JOB DESCRIPTION
TITLE: Pharmacy Revenue Integrity Specialist
REPORTS TO POSITION: 340B Program Manager
DEPARTMENT: Pharmacy
DATE LAST REVIEWED: August 2024
OUR VISION: Creating America’s healthiest community, together
OUR MISSION: In the spirit of love and compassion, better health, better care, better value
OUR VALUES: Accountability, Caring and Teamwork
DEPARTMENT SUMMARY: The St. Charles Health System Pharmacy provides a broad range of hospital and outpatient pharmaceutical care services to deliver high quality, effective, safe, reliable, and affordable medication therapy for our patients.
POSITION OVERVIEW: The Pharmacy Revenue Integrity Specialist at St Charles Health System (SCHS) supports all pharmacy departments and service lines, identifying billing issues and making corrections. This position serves as a liaison to EHR analysts, Pharmacy, Revenue Cycle, Charge-master, and operation teams to ensure that medication bill codes and modifiers are applied correctly, ensuring accurate and compliant billing practices. This position works closely with the 340B team due to how pharmacy billing methodology intersects with the 340B drug pricing program. This position will be expected to participate in 340B education and training to assist with ensuring compliance. This position does not directly manage other caregivers.
ESSENTIAL FUNCTIONS AND DUTIES:
Reviews and corrects pharmacy charges triggering 3rd party edits or revenue guardian checks.
Audits, trains, and educates pharmacy department caregivers assigned to working decentralized edits, revenue guardian checks, and the charge review work queues.
Researches and resolves revenue code, modifiers, and other issues.
Identifies services that are reimbursable but are not being coded; reviews, assigns, and validates revenue codes.
Supports clinical areas and departments in charge capture, coding accuracy, resolution of regulatory and payer specific edits, and revenue management to ensure organization-wide uniformity of charges and coding for similar services and procedures.
Identifies/investigates issues with medical necessity, coding, and billing that reduce reimbursement; recommends action steps and works collaboratively with the departments and clinics to improve processes when operational weaknesses and/or compliance issues are found.
Assists with 340B program maintenance and auditing.
Completes and provides management reports as requested.
Conducts all activities with the highest standards of professionalism and confidentiality.
Complies with all applicable laws, regulations, policies and procedures, supporting the health system’s corporate integrity efforts by acting in an ethical and appropriate manner, reporting known or suspected violations of applicable rules, and cooperating fully with all company investigations and proceedings.
Supports the vision, mission, and values of the organization in all respects.
Supports Lean principles of continuous improvement with energy and enthusiasm, functioning as a champion of change.
Provides and maintains a safe environment for caregivers, patients and guests.
Conducts all activities with the highest standards of professionalism and confidentiality.
Complies with all applicable laws, regulations, policies and procedures, supporting the organization’s corporate integrity efforts by acting in an ethical and appropriate manner, reporting known or suspected violation of applicable rules, and cooperating fully with all organizational investigations and proceedings.
Delivers customer service and/or patient care in a timely, efficient and accurate way.
May perform additional duties of similar complexity within the organization, as required or assigned.
EDUCATION:
Required: High school diploma or GED.
Preferred: Bachelor’s degree in health information or healthcare administration.
LICENSURE/CERTIFICATION/REGISTRATION:
Required: Oregon Board of Pharmacy Technician license. Valid Oregon driver’s license and ability to meet SCHS driving requirements.
Preferred: One or more of the following: RHIA, RHIT, CCS, or CPC certification; 340B ACE Certificate.
EXPERIENCE:
Required: Three (3) years health system Pharmacy Technician experience.
Preferred: Three (3) or more years in coding/auditing, billing edits, and resolutions in health system setting.
PERSONAL PROTECTIVE EQUIPMENT:
Must be able to wear appropriate Personal Protective Equipment (PPE) required to perform the job safely.
PHYSICAL REQUIREMENTS:
Continually (75% or more): Use of clear and audible speaking voice and the ability to hear normal speech level.
Frequently (50%): Sitting, keyboard operation.
Occasionally (25%): Standing, walking, bending, stooping/kneeling/crouching, climbing stairs, reaching overhead, lifting/carrying/pushing or pulling 1-10 pounds, grasping/squeezing, operation of a motor vehicle, ability to hear whispered speech level.
Never (0%): Climbing ladder/step-stool, lifting/carrying/pushing or pulling 11-50 pounds.
Exposure to Elemental Factors
Occasionally (25%): Chemical solution for Laboratory Caregivers.
Rarely (10%): Wet/slippery area.
Never (0%): Heat, cold, noise, dust, vibration, chemical solution, uneven surface.
Blood-Borne Pathogen (BBP) Exposure Category
Risk for Exposure to BBP
.
Schedule Weekly Hours:
40Caregiver Type:
RegularShift:
First Shift (United States of America)Is Exempt Position?
YesJob Family:
SPECIALIST PHARMACYScheduled Days of the Week:
Monday-FridayShift Start & End Time:
Website: https://stcharleshealthcare.org/
Headquarter Location: Bend, Oregon, United States
Employee Count: 1001-5000
Year Founded: 2001
IPO Status: Private
Industries: Health Care ⋅ Medical ⋅ Non Profit