The Centers for Medicare and Medicaid Services (CMS), a federal agency, is requiring COVID-19 vaccination of staff at health care facilities that participate in the Medicare and Medicaid programs. All associates are required to provide proof of the COVID-19 vaccination. Exemptions may be accepted as an accommodation under the Americans with Disabilities Act (ADA), or religious beliefs, observances, or practices established under Title VII of the Civil Rights Act of 1964.
If you are offered and accept a position with SRHS, you will be required to provide proof of vaccination or will be given the opportunity to request a medical or religious exemption for consideration.
Pharmacy Business Integrity Analyst
- Spartanburg, SC
- Spartanburg Medical Center
- Pharmacy Admin and Support
- Full-Time - Days - M-F; 8:00-4:30
- Job Grade E09
- Req #: 40216
In coordination with the System Director of Pharmacy, the Pharmacy Operations Manager and the Vice President of Corporate Integrity, the Pharmacy Business Integrity Analyst will be responsible for ensuring medication charge integrity, reimbursement, and compliance for the healthcare system via data analysis, audit, and proactive drug file management to maximize system drug revenue and billing compliance. The analyst will be responsible for all facets of hospital pharmacy practice including acute care, infusion, and any related 340B overlap. The analyst will be responsible for development and/or maintenance of policies and procedures to ensure best practice, maintain pharmacy compliance, and maximize/maintain pharmacy revenue and expected to routinely report findings to the System Director of Pharmacy, the Pharmacy Operations Manager and the Vice President of Corporate Integrity. The analyst is responsible for interacting across multiple departments (i.e. IT, 340B Program, hospital/physician billing, pharmacy, etc.) to develop collaborative solutions that drive positive pharmacy business outcomes.
- Bachelor’s Degree in healthcare, business, accounting, or related field
- Seven years of relevant experience may be considered in lieu of the education degree requirement
- Requires 5-10 years full-time healthcare business or operations experience, preferably in a hospital setting
- Demonstrated general knowledge of billing and coding rules and regulations for governmental and managed care payers.
- Highly proficient in Microsoft Office with an emphasis in Microsoft Excel
- Experience leading small groups to facilitate outcomes, communicating outcomes to hospital leadership, auditing for compliance, analyzing financial impact of a department/business unit
- Intermediate to advanced-level analytical skills to provide data-driven recommendations
- Attention to detail, excellent organizational skills
- Self-directed, motivated and able to work independently
- Flexible in responsibilities and work schedule
- 340B university (must be completed within 1 year of hire date)
- 1-3 years of experience related to hospital or professional billing, medical coding, EMR Informatics, chargemaster maintenance or charge/coding audits preferred
- Supervisor or Coordinator experience preferred
- EPIC experience preferred
- 340B and/or Pharmacy experience preferred
- Knowledge of medication charge capture processes and EMR medication file infrastructure preferred
- Strong communication skills preferred
- CPC, RHIT or equivalent coding certification
Core Job Responsibilities
MEDICATION CHARGE INTEGRITY & CHARGE DESCRIPTION MASTER (CDM) MAINTENANCE
- Serves as the Pharmacy primary point of contact for all charging, coding, billing related issues.
- Monitors and resolves Account, Charge Review and Claim Edit work queue for designated System Pharmacy departments
- Monitors and resolves charge discrepancies found utilizing EPIC reports for charge/revenue optimization and accuracy
- Processes charge corrections necessary by bulk charge functions.
- Monitors targeted drug charge audit reports to ensure proper charging and processes corrections as needed.
- Prepares and presents reports detailing repeat charge/coding errors and facilitates work groups or actions necessary to identify resolutions
- Coordinates all necessary communication and resolutions regarding large scale medication file changes, billing changes/updates, EMR special workflows/rules to ensure pharmacy charge/billing compliance.
- Ensures pharmacy drug costs are updated within EMR upon designated schedule set forth by Business Services/Finance Leaders. Facilitates the Internal Pharmacy review and sign off to the Application Analyst prior to final submission to the EMR.
- Coordinates information needed by Finance to maintain Pharmacy Cost Accounting data within the Financial Cost Accounting software
- Performs at minimum quarterly audits for drug file (ERX and NDC) standardization discrepancies; submits discrepancies for correction in a timely manner
- Coordinates/facilitates all quarterly update requests to Medication records to the Application Analyst in a timely manner.
- The analyst will develop a tracking system for medication file changes and maintain updates to the System Pharmacy CDM Strategy documentation.
- Responsible for researching all payor claim edits related to medications and working closely with Business Services and IT on recommendations for resolution.
- Responsible for review/research of all Medicare and/or Payer’s new requirements, updates and/or changes that effect billing to determine the items that require action.
- Monitors CMS for updates that affect medication records and pharmacy billing requirements.
- Work Closely with the Revenue Integrity team and Charge Master Analyst regarding new services as it relates to charging/billing.
- Work Closely with the Infusion Pharmacy Manager regarding new medications or alternative therapies to provide reimbursement evaluations and considerations.
- Research medication coding, coverage, reimbursement and other compliance or reimbursement issues related to pharmacy charging/billing.
- Analyst will develop and maintain a tracking system for Outpatient Drug Reimbursement reviews and provide updates to drive positive financial outcomes.
- Monitors CMS and State Medicaid requirements for 340B claims filing guidelines and facilitates necessary updates to EMR settings to ensure timely and accurate 340B reporting.
- Monthly audits of hospital charges related to 340B Medicaid claims to ensure billing compliance.
- Monthly audits of hospital charges related to 340B CMS claims to ensure billing compliance.
- Assists 340B Program with Hospital & Retail audits as needed.
- Generate daily, weekly, and monthly data files and/or reports to support the data exchange and integrity of the 340B program.
OTHER DUTIES AS ASSIGNED
- Attend educational sessions/seminars directly related to area of responsibility as requested by Manager/Director.
- Effectively facilitates multi-disciplinary initiatives with the various teams throughout the health system or external customers.
NOTE: These bulleted items are intended to describe the essential functions of the job and are not intended to be a complete list of all responsibilities. Skills and duties may vary dependent upon our department. Other duties may be assigned as required.
Spartanburg Regional is an integrated healthcare system that provides care from birth to hospice. As a a partner with the community for 90 years, we have earned a reputation for technological excellence. With more than 5,600 employees, Spartanburg Regional prides itself in being one of the most recognized healthcare facilities in Upstate South Carolina. A long list of accolades and accomplishments keep our employees proud. We believe the pride and quality in our organization is the result of a focused effort of our staff and resources.
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