Certified Pharmacy Revenue Integrity Specialist FT

Department:

38500 Retail Pharmacy - Pharmacy Business Operations

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

40

Schedule Details/Additional Information:

Full Time. Remote. Monday-Friday. 7:30AM-4:00PM CST/8:30AM-5:00PM EST

Pay Range

$24.85 - $37.30

EDUCATION/EXPERIENCE: High School Diploma or GED required. Bachelors Preferred. CPhT preferred. Prior technician experience in Hospital or Retail Pharmacy. Strong knowledge of medical terminology, and anatomy & physiology. 1-2 years' pharmacy experience with or exposure to Epic/Encompass billing system. Prior experience with Pharmaceutical Charging and/or reimbursements.

LICENSURE, CERTIFICATION, and/or REGISTRATION: CPhT preferred

Essential Functions:

Maintains a comprehensive and current level of knowledge of new developments and issues related to coding, charge capture, accounting, and billing compliance in the healthcare environment.

Serves as a resource for department managers, staff, and administration to obtain information on guidelines and regulatory standards of coding and billing.

Documents and/or reviews all data collected during the review, identifying all billing, coding and documentation errors.

Reviews clinical documentation to ensure accurate CPT/HCPCS code assignment and appropriate reimbursement.

Utilizes findings to develop and coordinate educational and training programs for specific functional areas for hospital departmental staff.

Verifies the validity of data and reports used and generated and adhere to system policies and procedures.

Follows through to ensure that any critical corrective action is taken and evaluates efficiency of interventions.

Prepares management reports, spreadsheets and executive summaries of review findings.

Plans scope of review and communicates plan with leadership.

Skills/Qualifications:

• EPIC and MacroHelix experience desired
• Analytical skills
• Communication skills (written, verbal and listening)
• Ability to multitask and juggle various projects simultaneously
• Understanding of pharmacy insurance billing, denials and third party payer audits is preferred.

Work Environment:

Clean, comfortable, office environment

Physical Requirements:

0% 35% 65%

To To To

35% 65% 100% N/A Activity

X Standing

X Walking

X Sitting

X Bending

X Reaching with arms

X Finger and hand dexterity

X Talking

X Hearing

X Seeing

Lifting, carrying, pushing and or pulling:

X 20 lbs. maximum

X 50 lbs. maximum

X 100 lbs. maximum

Our Commitment To You:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift, on call, and more based on a teammate's job
• Incentive pay for select positions
• Opportunity for annual increases based on performance

Benefits And More

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance and paid parental leave
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program

About Advocate Health

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.