Phoenix Children's Hospital, Inc.
Pharmacy Billing Specialist New! Pharmacy Admin | Full-Time | Phoenix Posting No
Phoenix Children's Hospital, Inc., Phoenix, Arizona, United States, 85003
Overview
Posting Note: This is an onsite, full time, hourly position. This position works within the Pharmacy Revenue Cycle Team to support all assigned pharmacy billing functions. Duties include manual review of identified billing claims through fatal edit reports, reviewing and resolving billing tickets, auditing charge master for appropriateness in built charges, and quarterly reviewing CMS changes in billing requirements. This position will also help develop and maintain SOPs to ensure pharmacy billing functions are optimized to changes in billing requirements. This position reports to the Director of Pharmacy Business Operations, and works closely with Revenue Cycle, and the 340B Team. Phoenix Children's has a great work culture, and we are looking for an individual with an emphasis on cultural fit, ability to continually learn, and has a “builder” mindset to develop and maintain pharmacy revenue cycle functions. The Pharmacy Billing Specialist will serve as the point of contact for all medication billing related activities throughout the inpatient and ambulatory sites of care. Scope of work for this role may include the review of medication charges and revenues, research incomplete information related to billing errors/denials, audit existing medication charges, and develop/maintain billing workflows. This individual also ensures new medication billing rules and regulatory changes (CMS and payors) are assessed for compliance, timely processes invoices, and assists in the development of policies and procedures. The Pharmacy Billing Specialist primarily collaborates with Revenue Cycle teams and directly reports to the Director of Pharmacy Business Operations.
Position Duties
Serve as the point-of-contact for pharmacy billing; actively reviews and resolves billing issues related to charge codes, errors, exceptions, denials, and workflows; collaborates with and provides guidance primarily to Revenue Cycle teams; proactively escalates billing issues or critical insights to Pharmacy leadership and Revenue Cycle teams. Resolve admit/discharge related medication charge errors Perform Medicare edits in PFM (finance system) in conjunction with IT Pharmacists Process credits for doses returned to pharmacy Manage cost transfers to other departments each month in a timely manner Complete Medicare rebills where they arise in pharmacy and external department charges and systems Review and update existing pharmacy billing processes/workflows and develop new standard operating procedures (SOPs) with Revenue Cycle, IT, and Pharmacy leadership for systems including: Automated dispensing systems (e.g., Omnicell); Pharmacy IT and Clinical systems (SRx/SCM) Allscripts; Patient financial systems (PFM) Allscripts; Manual charge sheets and department databases; Patient access system (SAM) Allscripts Perform ongoing audits to ensure built medication charges comply with departmental, Medicare, Medicaid, Commercial Payors, and State policies and guidelines. Receive, forward for review, and process invoices with Accounts Payable. Maintain professional and technical competency in pharmacy billing through training and certifications. Participate in Pharmacy Business Operations, Office of Business Integrity and other ad hoc committees related to medication and pharmacy charge and billing integrity. Perform miscellaneous duties as requested.
Phoenix Children\'s Mission, Vision, & Values
Mission: To advance hope, healing and the best healthcare for children and their families Vision: Phoenix Children\'s will be the leading pediatric health system in the Southwest, nationally recognized for exceptional care, innovative research and advanced medical education. Offering the most comprehensive care across ages, communities and specialties Investing in innovative research, including emerging treatments, tools and technologies Advancing education and training to shape the next generation of clinical leaders Advocating for the health and well-being of children and families Values: We place children and families at the center of all we do We deliver exceptional care, every day and in every way We collaborate with colleagues, partners and communities to amplify our impact We set the standards of pediatric healthcare today, and innovate for the future We are accountable for making the highest quality care accessible and affordable
Apply for this position
Note: This section was part of the original application form; it has been streamlined for readability in this description.
Position Qualifications
Education High school diploma or equivalent (Required) Associates or Bachelors degree in a related field or equivalent (Preferred) Experience Minimum of one year of experience/exposure to pharmacy billing, medical billing, or equivalent (Required) Moderate competency in Excel (Required) Knowledge of HCPCS codes, modifiers, ICD-10/CPT codes, and government/commercial payor guidelines (Preferred) Knowledge of reimbursement, medical terminology, and HIPAA privacy laws (Preferred) Two years of acute healthcare environment or equivalent (Preferred) Advanced knowledge in pharmacy coding, billing, and invoicing (Preferred) Knowledge of professional fee billing (Preferred) Allscripts EHR and Image Express experience (Preferred)
Special Skills
Proficient with data and document programs (Word, Excel, Access, Pivot Tables) (Required) General knowledge of 340B Program and drug purchasing programs (Preferred) Auditing experience (Preferred)
Additional Requirements
Current license and registered as a Pharmacy Technician in Arizona (CPhT Certification from PTCB) (Preferred) Pharmacy Billing and Reimbursement Certificate from PTCB (Preferred) CPhT-Adv Certification from PTCB (Preferred) Professional Coding Certification (CPC) (Preferred)
Physical Requirements & Occupational Exposure/Risk Potential
List of requirements as in original; kept concise
I have reviewed the qualifications, physical requirements and occupational exposure/risk potential for this position and wish to apply I Agree
#J-18808-Ljbffr
Posting Note: This is an onsite, full time, hourly position. This position works within the Pharmacy Revenue Cycle Team to support all assigned pharmacy billing functions. Duties include manual review of identified billing claims through fatal edit reports, reviewing and resolving billing tickets, auditing charge master for appropriateness in built charges, and quarterly reviewing CMS changes in billing requirements. This position will also help develop and maintain SOPs to ensure pharmacy billing functions are optimized to changes in billing requirements. This position reports to the Director of Pharmacy Business Operations, and works closely with Revenue Cycle, and the 340B Team. Phoenix Children's has a great work culture, and we are looking for an individual with an emphasis on cultural fit, ability to continually learn, and has a “builder” mindset to develop and maintain pharmacy revenue cycle functions. The Pharmacy Billing Specialist will serve as the point of contact for all medication billing related activities throughout the inpatient and ambulatory sites of care. Scope of work for this role may include the review of medication charges and revenues, research incomplete information related to billing errors/denials, audit existing medication charges, and develop/maintain billing workflows. This individual also ensures new medication billing rules and regulatory changes (CMS and payors) are assessed for compliance, timely processes invoices, and assists in the development of policies and procedures. The Pharmacy Billing Specialist primarily collaborates with Revenue Cycle teams and directly reports to the Director of Pharmacy Business Operations.
Position Duties
Serve as the point-of-contact for pharmacy billing; actively reviews and resolves billing issues related to charge codes, errors, exceptions, denials, and workflows; collaborates with and provides guidance primarily to Revenue Cycle teams; proactively escalates billing issues or critical insights to Pharmacy leadership and Revenue Cycle teams. Resolve admit/discharge related medication charge errors Perform Medicare edits in PFM (finance system) in conjunction with IT Pharmacists Process credits for doses returned to pharmacy Manage cost transfers to other departments each month in a timely manner Complete Medicare rebills where they arise in pharmacy and external department charges and systems Review and update existing pharmacy billing processes/workflows and develop new standard operating procedures (SOPs) with Revenue Cycle, IT, and Pharmacy leadership for systems including: Automated dispensing systems (e.g., Omnicell); Pharmacy IT and Clinical systems (SRx/SCM) Allscripts; Patient financial systems (PFM) Allscripts; Manual charge sheets and department databases; Patient access system (SAM) Allscripts Perform ongoing audits to ensure built medication charges comply with departmental, Medicare, Medicaid, Commercial Payors, and State policies and guidelines. Receive, forward for review, and process invoices with Accounts Payable. Maintain professional and technical competency in pharmacy billing through training and certifications. Participate in Pharmacy Business Operations, Office of Business Integrity and other ad hoc committees related to medication and pharmacy charge and billing integrity. Perform miscellaneous duties as requested.
Phoenix Children\'s Mission, Vision, & Values
Mission: To advance hope, healing and the best healthcare for children and their families Vision: Phoenix Children\'s will be the leading pediatric health system in the Southwest, nationally recognized for exceptional care, innovative research and advanced medical education. Offering the most comprehensive care across ages, communities and specialties Investing in innovative research, including emerging treatments, tools and technologies Advancing education and training to shape the next generation of clinical leaders Advocating for the health and well-being of children and families Values: We place children and families at the center of all we do We deliver exceptional care, every day and in every way We collaborate with colleagues, partners and communities to amplify our impact We set the standards of pediatric healthcare today, and innovate for the future We are accountable for making the highest quality care accessible and affordable
Apply for this position
Note: This section was part of the original application form; it has been streamlined for readability in this description.
Position Qualifications
Education High school diploma or equivalent (Required) Associates or Bachelors degree in a related field or equivalent (Preferred) Experience Minimum of one year of experience/exposure to pharmacy billing, medical billing, or equivalent (Required) Moderate competency in Excel (Required) Knowledge of HCPCS codes, modifiers, ICD-10/CPT codes, and government/commercial payor guidelines (Preferred) Knowledge of reimbursement, medical terminology, and HIPAA privacy laws (Preferred) Two years of acute healthcare environment or equivalent (Preferred) Advanced knowledge in pharmacy coding, billing, and invoicing (Preferred) Knowledge of professional fee billing (Preferred) Allscripts EHR and Image Express experience (Preferred)
Special Skills
Proficient with data and document programs (Word, Excel, Access, Pivot Tables) (Required) General knowledge of 340B Program and drug purchasing programs (Preferred) Auditing experience (Preferred)
Additional Requirements
Current license and registered as a Pharmacy Technician in Arizona (CPhT Certification from PTCB) (Preferred) Pharmacy Billing and Reimbursement Certificate from PTCB (Preferred) CPhT-Adv Certification from PTCB (Preferred) Professional Coding Certification (CPC) (Preferred)
Physical Requirements & Occupational Exposure/Risk Potential
List of requirements as in original; kept concise
I have reviewed the qualifications, physical requirements and occupational exposure/risk potential for this position and wish to apply I Agree
#J-18808-Ljbffr