Job Description
Salary: 25.79-38.69 USD
Facility: Sisters of Charity Hospital
Shift: Shift 1
Status: Full Time FTE: 1.000000
Bargaining Unit: ACE Associates
Exempt from Overtime: Exempt: No
Work Schedule: Days and Evenings
Hours: 7a-3p, 8a-4p, 9a-5p, varies
Summary:
Under the direction of the Director of Pharmacy including oversight Pharmacy Manager(s) and site and System revenue cycle leadership, the Pharmacy / Infusion Revenue Specialist will be responsible to participate in oversight of charge capture, charge review, appropriate documentation and work queue edits. This position serves as the primary contact/resource for Patient Financial Services, Revenue Integrity and Outpatient Clinical Documentation Integrity (CDI) programs.
The position requires advanced knowledge of program requirements of various insurance providers as well as federal research billing rules, Medicare and Medicaid as well as medications, 340B, and medication procurement processes. The incumbent actively participates as needed in both external third-party audits and in internal audits and as well as quality improvement initiatives, documentation of current workflows, assists with special projects, and works closely with Infusion Center teams, Catholic Health fiscal teams, Infusion Center Leadership, and Prior Authorization teams. The employee performs complex patient account follow-up activities and actively participates in quality improvement initiatives to improve charging and documentation processes. The Pharmacy / Infusion Revenue Specialist is also responsible for the provision of accurate and timely support for appeals processing to various pertinent health system teams or programs. The incumbent will also provide support, as needed, for various aspects of the formulary process including reimbursement, financial analysis and report generation.
Responsibilities:
EDUCATION
- Associate degree required - Science, Business, or Technology related field preferred
- Bachelor's Degree preferred
- Considerable experience in areas noted below will be considered in lieu of degree
EXPERIENCE
- Twenty-four (24) months experience in healthcare, business, or IT setting
- Revenue capture experience desirable
- Experience dealing with health insurance, prior authorizations and claims resolution desirable
- Experience with documentation and documentation issue resolution desirable
- Experience as certified pharmacy technician, purchaser or operations specialist preferred
- Knowledge of medical and pharmacy terminology desirable
KNOWLEDGE, SKILL AND ABILITY
- Strong communication, interpersonal, organizational, and computer skills
- Proficient in gathering, analyzing and interpreting data, and working both independently and as part of a team to solve problems, make and implement recommendations
- Proficient with computers, software applications, and report generation
- Ability to establish working relationships with both professional and support personnel
- Ability to prioritize work assignments and work independently to manage multiple ongoing projects
- Acute awareness of confidentiality requirements
- Comfort with and willingness to make and implement recommendations
- Ability to work in matrix management organization
- High Tolerance for ambiguity and uncertainty
- Detail oriented and quality driven
WORKING CONDITIONS:
- Office type conditions with considerable sitting and computer work
- Works unusual hours as required to complete assignmentsand projects and in preparation for meetings, surveys etc. Travels to other Catholic Health hospitals and locations as required
