Revenue Integrity Coordinator (Pharmacy) Job at Cooper Green
Revenue Integrity Coordinator (Pharmacy)
Job ID: 13634
Functional Area: Health/Medical
Position Type: Full Time
Experience Required: 3 - 5 Years
Location: Birmingham, AL
Department: PHA-Pharmacy
Education Required: Bachelors Degree
Relocation Provided: No
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Position Description:
Welcome to the Applicant Portal for Cooper Green Mercy!
Located in the vibrant and historic city of Birmingham, Cooper Green is an ambulatory care facility dedicated to serving the residents of Jefferson County. By visiting this website, you’ve taken the first step toward a fulfilling future.
Our vision: Be the choice for care in our community.
Our mission: Serving all residents of Jefferson County, Alabama, through respectful, comprehensive, patient-centered care to achieve optimal health and a higher quality of life, regardless of ability to pay.
Commitment to Diversity: Cooper Green Mercy Health Services Authority, an affiliate of UAB Health System is an ambulatory care clinic that strives to provide an environment where our patients, employees and providers have a sense of belonging, dignity, and respect. We are committed to improving the health and lives of those we serve. We will act with intentionality to innovate, attract a workforce that represents the community we serve, invest in our community, and educate our workforce to be culturally competent and socially responsible.
We’re looking for like-minded individuals driven to make a difference. We invite you to explore careers at Cooper Green.
GENERAL SUMMARY
The Pharmacy Revenue Integrity Specialist is responsible for ensuring optimal revenue capture for pharmaceuticals.
Hours: Monday-Friday 8:00AM to 5:00PM
KEY RESPONSIBILITIES
The Pharmacy Revenue Integrity Specialist will:
Welcome to the Applicant Portal for Cooper Green Mercy!
Located in the vibrant and historic city of Birmingham, Cooper Green is an ambulatory care facility dedicated to serving the residents of Jefferson County. By visiting this website, you’ve taken the first step toward a fulfilling future.
Our vision: Be the choice for care in our community.
Our mission: Serving all residents of Jefferson County, Alabama, through respectful, comprehensive, patient-centered care to achieve optimal health and a higher quality of life, regardless of ability to pay.
Commitment to Diversity: Cooper Green Mercy Health Services Authority, an affiliate of UAB Health System is an ambulatory care clinic that strives to provide an environment where our patients, employees and providers have a sense of belonging, dignity, and respect. We are committed to improving the health and lives of those we serve. We will act with intentionality to innovate, attract a workforce that represents the community we serve, invest in our community, and educate our workforce to be culturally competent and socially responsible.
We’re looking for like-minded individuals driven to make a difference. We invite you to explore careers at Cooper Green.
GENERAL SUMMARY
The Pharmacy Revenue Integrity Specialist is responsible for ensuring optimal revenue capture for pharmaceuticals.
Hours: Monday-Friday 8:00AM to 5:00PM
KEY RESPONSIBILITIES
The Pharmacy Revenue Integrity Specialist will:
- Serve as a liaison between Finance, Revenue Integrity, Compliance, Pharmacy, Medication Services Committee, UAB Purchasing, and other departments to standardize and optimize pharmacy charging workflows, pharmacy revenue, business processes, billing, denial management, and collections.
- Work with clinical staff, managed care, and the business office to decrease mediation related claim denials and outstanding claims.
- Provide education to Cooper Green staff and system stakeholders to drive optimal revenue capture.
- Act as the system expert on medication-related compliance billing and charging topics.
- Develop policies and/or guidelines to improve revenue integrity, capture, and compliance.
- Participate in the financial analyses of any proposed changes to determine charge and revenue implications related to the pharmacy charge description master (PCDM) maintenance.
- Communicated findings to management and overseeing the implementation of approved recommendations to ensure appropriate revenue capture.
- Develop policies, guidelines, and procedures for pharmaceutical coding, billing, pricing, charging, and denial management to maximize reimbursement and compliance charging.
- Develop quality metrics and audit methodologies to drive accuracy and first time quality for all HCPCS/CPT codes, revenue codes, billable units, multipliers, modifiers, indications, etc.
- Develop analytical tools to audit and analyze ambulatory care pharmacy data elements to ensure accurate billing and maximal revenue capture.
- Perform quality reviews in order to ensure that PCDM additions, inactivation’s, changes and/or revisions were accurately completed in the hospitals clinical and financial systems.
- Work with Medication Services Committee, Oncology/Hematology, and Managed Care to align formularies.
- Actively research and stay current with important billing and revenue related compliance and optimization topics to guide appropriate organizational decisions.
- Participate and lead committees, work groups, process improvement efforts, and educational initiatives to improve pharmacy revenue integrity and the pharmacy billing cycle.
- Develop process flows, education, and communications to improve revenue integrity and compliance.
- May need to lift up to 30lbs on occasion.
- Other duties as assigned.
Position Requirements:
MINIMUM QUALIFICATIONS
CLOSING DATE: March 3, 2023
MINIMUM QUALIFICATIONS
- Required: Bachelor’s Degree in Pharmacy.
- Preferred: Currently Registered as a licensed pharmacist by the Alabama Board of Pharmacy (ALBOP)
- Required: Proficiency in Microsoft Excel, PioneerRx, Omnicell, and other pharmacy program databases.
- Required: 3+ years of experience with outpatient pharmacy experience in operations, infusion/oncology billing, retail pharmacy billing, compliance and disputing pharmacy reimbursement denials.
- Preferred: MBA, MISM, PharmD, or other informatics training.
- Preferred: Advanced experience with Microsoft Excel & Access and Omnicell.
- Preferred: 10+ years of experience with PioneerRx maintenance, CDM Maintenance, and/or Omnicell
CLOSING DATE: March 3, 2023
Cooper Green Mercy Health Services Authority is proud to be an AA/EOE/M/F/Vet/Disabled employer.
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