Pharmacist - Pharmacy Revenue Integrity

UNC Health Care Systems Morrisville , NC 27560

Posted 4 months ago

Position: Pharmacist / Pharmacy Revenue Integrity

Location: Lenovo Building / Morrisville

Hours: Full Time, 40 hrs/wk; Days

Position Summary:

The Revenue Integrity pharmacist will join the Pharmacy Revenue Integrity (PRI) team, which includes a Business Analytics Specialist, a Reimbursement Analyst, a Charge Integrity Analyst, a Denials Specialist and a Revenue Integrity Pharmacist. The PRI team works with the Pharmacy Medication Assistance Program (MAP) team, the Epic Willow team, Pharmacy Analytics, the Pharmacy Business Office, and the various pharmacy clinical and operational area teams, in addition to developing and sustaining communication channels with the Revenue Cycle, Patient Financial Services, Hospital Billing, Managed Care, and Health Information Management departments to ensure clarity, consistency and accuracy around the pharmacy charge, reimbursement and revenue cycle.

The Revenue Integrity Pharmacist will work with the PRI team to evaluate all the pharmacy claims denials, process discrepancies and identify areas for workflow improvement through routine data analysis using internal databases and key performance indicators. Best practices in pharmacy denials management will be identified and developed to ensure the department is fiscally responsible and compliant with all commercial, state and federal regulations.

The Revenue Integrity pharmacist will provide regular updates to executive and pharmacy leadership through area assessments and compliance improvement recommendations. A dashboard summary of payor denial work queues and recommendations will be presented to Pharmacy leadership and appropriate UNC Medical Center/Health Care System committees.

Reporting Relationships:

The Revenue Integrity Pharmacist will report directly to the Assistant Director of Pharmacy over MAP Services and Pharmacy Revenue Integrity. The pharmacist will operate and be physically located in Morrisville, but will spend time at the UNC Medical Center as needed.

Key Responsibilities:

The responsibilities of the Revenue Integrity Pharmacist include, but are not limited to, the following:

  • Proactively maintain specific payor denial work queues, researching payor coverage policies and appeal requirements, auditing patient account histories, and submitting required documentation to payors.

  • Identify, analyze and research frequent root causes of denials and develop corrective action plans for resolution.

  • Develop reporting tools that effectively measure and monitor processes throughout the denials management process

  • Lead chart audits and conduct internal audits of claims and payment to assure that uncompensated patient revenues resulting from denials of patient service billings are minimized.

  • Provide clinical and pharmacy operational expertise to assist PRI Denials Specialist in overturning denials

  • Research, respond and document insurer and patient correspondence / inquiry notes regarding coding coverage, benefits and reimbursement on patient accounts.

  • Collaborate with the pharmacy pre-certification team in quality improvement initiatives.

  • Develop and sustain routine communication channels with the billing, finance, accounting, and Health Information Management departments and clarity, consistency and accuracy around the pharmacy reimbursement and revenue cycle.

  • Develop a performance improvement plan that will record and trend high dollar charges and denials.

  • Prepare financial/regulatory/quality analysis reports for departmental leadership and staff.

  • Compile, analyze, and report on the financial performance of departmental operating units.

  • Maintain a current knowledge of payor and regulatory guidelines for medical insurance claims processing and reimbursement.

  • Participate in departmental lean quality events.

  • Participate in departmental and hospital committees.

Skills and Attributes:

The Revenue Integrity Pharmacist should demonstrate or be willing to learn the following skills and attributes:

  • Hospital billing (CPT/HCPCS/Revenue Codes), CDM drugmaster maintenance (ERX), and patient accounts

  • Demonstrated understanding of medical terminology required

  • Knowledge of CPT, HCPCS, and ICD10 coding

  • Knowledge of patient confidentiality and HIPAA regulations

  • Knowledge of medical billing and collection practices

  • Understanding of Medicare and Medical Assistance regulations as they apply to job functions

  • Knowledge working with electronic health records (EHR/EMR) or healthcare related computer systems

  • Excellent written and verbal skills are required as well as outstanding interpersonal skills

  • Efficient methods for getting work done; strong ability to prioritize workload

  • Organized; sets priorities; meets deadlines

  • Ability to work independently

Preferred Experience:

  • Preferred PGY1 and/or PGY2 residency

  • Demonstrated proficiency with EPIC Healthcare software

  • Experience with Windows, Excel, PowerPoint, Business Objects, or other financial/analytical software

Bachelor's degree in Pharmacy. Licensed as a Registered Pharmacist and eligible to practice pharmacy in the state of North Carolina.

If a Bachelor's degree: Two (2) years of pharmacist experience.

If a PharmD degree: No prior experience required.


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Pharmacist - Pharmacy Revenue Integrity

UNC Health Care Systems