Reimbursement Analyst - Pharmacy Revenue Integrity

UNC Health Care Systems Morrisville , NC 27560

Posted 4 months ago

Position: Reimbursement Analyst

Location: Lenovo Building / Morrisville

Hours: Full Time, 40 hrs/wk; Days

Position Summary:

The Pharmacy Reimbursement Analyst will join the Pharmacy Revenue Integrity (PRI) team, which includes a Reimbursement Analyst, Charge Integrity Analyst, Business Analytics Specialist, 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 Pharmacy Reimbursement Analyst will perform financial analysis and reporting to maximize the collection of all pharmacy-related billable items, and ensure regulatory compliance.

The Pharmacy Reimbursement Analyst will provide regular updates to executive and pharmacy leadership through area assessments and compliance improvement recommendations, as well as routine dashboard reports.

Reporting Relationship:

The Pharmacy Reimbursement Analyst will report directly to the Assistant Director of Pharmacy over MAP Services and Pharmacy Revenue Integrity. The Pharmacy Reimbursement Analyst 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 Reimbursement Analyst include, but are not limited to, the following:

  • Act as a Pharmacy reimbursement business expert and revenue cycle liaison

  • Assist with chart audits and conducting internal audits of charges and payment to assure that uncompensated patient revenues are minimized.

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

  • Assist with and audit end-to-end pharmacy reimbursement and revenue cycle analysis to uncover pharmacy financial discrepancies and revenue loss due to coding errors and incorrect Charge Data Master mapping.

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

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

  • Review Add Sheets and non-formulary requests for new drugs to ensure billing information is accurate prior to being built in the electronic health record.

  • Routinely assess CPT/HCPCS changes and modify drug builds to reflect the most up to date billing information, mitigating future denials.

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

  • Initiate, extract, and analyze data elements to identify potential performance improvement and cost savings initiatives

  • Participate in departmental lean quality events.

  • Participate in departmental and hospital committees.

Skills and Attributes:

The Pharmacy Reimbursement Analyst 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 patient confidentiality and HIPAA regulations

  • Knowledge of medical billing and collection practices

  • Understanding of Medicare, Medicaid, Commercial payor 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:

  • Experience in finance, insurance, insurance appeals, medication and medical terminology required.

  • Masters Degree in Business and experience in a healthcare setting or physician's practice preferred.

  • Ability to work in self-directed manner while interacting with patients, prescribers and all medical center faculty and staff.

  • Ability to communicate clearly with health care team.

  • Strong demonstrated communication skills.

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

  • Must be highly organized, detail-oriented, and able to manage multiple projects at a time.

Bachelor's degree in an appropriate discipline (or equivalent combination of education, training and experience).

If a Bachelor's degree: No experience required.

If an Associate's degree: Four (4) years of experience in business analysis and planning, accounting, finance, health care administration or data base management/analysis.

If a High School diploma or GED: Eight (8) years of experience in business analysis and planning, accounting, finance, health care administration or data base management/analysis.


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Reimbursement Analyst - Pharmacy Revenue Integrity

UNC Health Care Systems