ChargeMaster, Revenue Integrity Analyst; Pharmacy

Job Details

Job Location:

340 B Contracting
- Memphis, TN 38103

Position Type:
Full Time

Travel Percentage:
Negligible

Job Shift: Day

Job Category:
Financial Services

Must have a Pharmacy Technician National Certification such as PTCB or NHA AND TN Pharmacy Tech License to qualify

Responsible for preventing and correcting issues related to billing, revenue and Charge Description Master (CDM) to ensure appropriate capture and reporting of revenue and maintain the integrity of systems in compliance with regulatory guidelines. Serves as liaison between pharmacy, finance and ancillary departments regarding revenue management initiatives and issues.

• Performs financial review and analysis to assist in resolving billing edits that are holding patient claims from billing, by reviewing medical records and other applicable documentation.
• Interact with ancillary departments to obtain additional information needed to properly bill account based on medical record.
• Identify charging, coding, or clinical documentation issues and work with ancillary departments to resolve issues and notify appropriate leadership.
• Review denial trends for documentation or charging issue opportunities.
• Reviews billing compliance correspondence and adheres to all guidelines.
• Performs assigned audits by researching documentation, analyzing information, and makes recommendations to improve flow of claim and enters all corrections into systems.
• Serves as liaison to include regular reviews of CPT codes, revenue codes, review of monthly standard CDM error report and communicating with Ancillary Departments to resolve issues.
• Coordinate educational in-services to Inpatient Pharmacy staff and Ancillary staff related to charging and billing issues.
• Assesses the accuracy of all medication charges.
• Understands and able to perform the balancing of charge posting from clinical and ancillary systems, checking per-edits from charge keying, working with Charge Description Master errors, rejects, late charges and other related duties of data control.
• Evaluates current charging and coding structures and processes in clinical/ancillary departments to ensure appropriate capture and reporting of revenue and compliance with government and third party payor requirements.
• Analyzes changes to coding and billing rules and regulations by utilizing appropriate reference materials, internet sources, seminars and publications.
• Provides guidance, communication and education on correct charge capture, coding and billing processes to finance and ancillary staff.
• Oversees the Pharmacy Charge Description Master (CDM) and monitor synchronization of item masters. Coordinate and communicate medication revisions (Add/delete/update) information in the CDM and other profiles and tables in accordance with Regional One Health and governmental policies and procedures. Understands and interprets Regional One Health, State and Federal guidelines and policies for billing technical charges related to medication charges. Utilizes operational and systems knowledge to communicate persuasively with departments to ensure correct interpretation of and compliance with guidelines.
  
  Utilizes investigational skills to determine when to contact other resources when dealing with unfamiliar clinical or operational situations.
• Works with Finance for all functions of the CDM information system and tool related to medications.
• Become expert in the use of the tools.
• Update item linkages as frequently as data is refreshed with the tools.
• Understands the workflow within the Charge Master so that CDM’s are maintained timely and such that all appropriate reviews are document.
• Research charging regulations as requested or required.
• Provides technical direction and assistance to…