Pharmacy Revenue Integrity Specialist

Summary:

Reports to the Department Coordinator for Revenue Cycle consults with Manager Oncology and Sterile Compounding Participates as a key member of the Brown University Health*s Revenue Cycle Team and Revenue Integrity Team. Monitors the accuracy of medication billing including but not limited to coding and charge capture assists with the prior authorization process and connecting patients with medication assistance programs. Identifies audits and provides monthly revenue data for medications that qualify for waste billing. Maintains on-going current working knowledge of manufacturer patient assistance programs (PAPs) co-pay assistance programs and insurance reimbursement. Manages patient medication requests in real time and updates the medication assistance program database. Works to minimize patient out-of-pocket expense and maximize the use of medication assistance programs and insurance reimbursement. Participates in continuous quality improvement activities and functions in a manner that contributes to a highly effective multidisciplinary work group.

Responsibilities:

PRINCIPAL DUTIES AND RESPONSIBILITIES:

Reviews and verifies new charge description master (CDM) drug builds to ensure the accuracy of all fields including but not limited to item description billing unit Health Care Common Procedure Coding Systems (HCPCS) code J code acquisition cost and charge price.

Audits the charge description master (CDM) periodically to verify the accuracy of existing data fields makes modifications if indicated.

Serves as the pharmacy point of contact for medication billing questions.

Serves as active member of Brown University Health*s Revenue Cycle Team and Revenue Integrity Team.

Provides pharmacy expertise to assist the Brown University Health Revenue Cycle Team with prior authorizations drug charges qualified waste billing and denials review.

Communicates effectively and professionally with patients health care providers insurance companies manufacturers and Brown University Health*s Revenue Cycle and Revenue Integrity Teams.

Facilitates the transition to preferred medications and biosimilars from eligibility prior authorization and billing perspectives.

Identifies and initiates systemic processes designed to help prevent inaccurate and/or incomplete charging coding and billing.

Identifies audits and provides monthly revenue data for medications that qualify for waste billing.

Develops a process to identify patients with outstanding balances. Determines eligibility for a manufacturer PAP or a copay assistance program. Identifies alternate billing options if any.

Enrolls eligible patients in PAP or copay assistance program. Initiates alternate billing options if any.

Analyzes and reviews charge reports and patient*s Medication Administration Record (MAR) to ensure accurate billing.

Audits white bagged medication charges to ensure they are appropriately charged with a $0.10 charge.

Documents audit and review activities maintains complete and accurate records.

Provides input on the development of policies and procedures related to revenue integrity and revenue cycle.

Maintains knowledge of and expertise in leading edge developments in medication billing revenue integrity and revenue cycle by participation in ongoing independent study education-related professional activities and affiliations.

Identifies and communicates quality and process improvement opportunities regarding third party billing and pharmacy revenue integrity and revenue cycle operations.

Participates in the development of tools and standards to establish and improve documentation of processes.

Other information:

BASIC KNOWLEDGE:

High school graduate or equivalent degree. Completion of one to two years of college preferred.

Maintains current unrestricted Rhode Island Pharmacy Technician licensure and National Pharmacy Technician Certification (CPhT) through Pharmacy Technician Certification Board (PTCB).

Billing and Reimbursement Certification through PTCB preferred.

EXPERIENCE:

Minimum of one-year pharmacy technician experience as a CPhT.

Effective problem solving and critical thinking skills.

Experience producing and analyzing data driven reports preferred.

Ability to communicate and present information effectively in both oral and written form with all levels of hospital personnel and all patient groups.

Strong customer service presence.

Must possess solid computer skills including Microsoft Office Suite as well as email and calendar applications. Must be comfortable in using internet web applications and multiple pharmacy and system-wide applications.

WORK ENVIRONMENT AND PHYSICAL REQUIREMENTS:

Requires ability to stay focused in a fast paced ever changing environment.

May require extended periods of time spent standing and walking.

Requires the visual acuity and manual dexterity necessary to operate a computer and using a typical keyboard and computer mouse to navigate screens on a computer monitor.

INDEPENDENT ACTION:

Performs independently within department policies and practices.

Refers specific complex problems to supervisor where clarification of departmental policies and procedures may be required.

SUPERVISORY RESPONSIBILITY:

None.

Brown University Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status. Brown University Health is a VEVRAA Federal Contractor.

Location: Rhode Island Hospital USA:RI:Providence

Work Type: Full Time

Shift: Shift 1

Union: Non-Union