Pharmacy Billing Specialist (FT) - Pharmacy- Oceanport, NJ
Job SummaryThe Pharmacy Billing Specialist coordinates and supports the Corporate Pharmacy department of RWJBarnabas Health efforts to reduce medication-related denials and maximize revenues for drug therapy and pharmacy related services as directed.
The position is part of an interdepartmental collaboration within RWJBarnabas Health and requires frequent interactions with the health system s business office members as well as the local affiliate hospitals.
The departments include, but are not limited to Revenue Cycle, IT&S, pharmacy informatics, pharmacy directors, managed care, compliance, oncology nursing, outpatient infusion and any areas where medications are administered.
The Pharmacy Billing Specialist also partners with Revenue Integrity to increase the accuracy and efficiency of the Pharmacy charge description master (CDM) for the entire health system.
The position objectives are to provide support to Corporate Pharmacy and RWJBarnabas Health and maximize institutional revenue.
Essential Job Functions Researches medication-related insurance claim denials Follows-up on unpaid or underpaid pharmacy claims Ability to complete appeals to insurance payors Monitors and reports outcomes of denials reviews and provides the recommendation for process improvements Communicates denial and billing issues to affiliate sites as necessary Performs technical review for medication formulary requests for Enterprise Clinical Information Systems (ECIS) Pharmacy Informatics & Revenue Integrity teams, include:
CPT/ HCPCS & revenue codes for accuracy & validity All potential modifiers Medication billing units (J-codes) NDC billing data fields Obtains approval for all additions, inactivation s, changes and/or revisions made to the CDM Communicates CDM changes to the appropriate facilities & individuals Reviews all aspects of billing and collections processes (e.
g.
billing, coding, ECIS, collections, contractual adjustments, denials, compliance, etc.
).
Identifies areas of improvement across and within processes Formulates recommendations and assists with implementation of changes Verifies medication charges are documented appropriately in financial, clinical and operational areas (i.
e.
ECIS, medical records, charge forms, itemized bills) Disseminates medication-related regulatory/coding/billing information to internal customers Responds to ad hoc medication billing or reimbursement questions Understands NDC requirements for state Medicaid and Managed Medicaid payors for billing hospital outpatient medications.
Assists in the development of an automated process to comply with NDC requirements Partners with Patient Accounting and Revenue Integrity to ensure denials and billing errors related to the Drug Chargemaster are addressed in a timely and accurate manner.
Analyzes and reviews drug and drug-related billing denials for medical necessity or any other coding specific denial reason.
Reviews Remittance Advice (RAs) and Explanation of Benefits (EOBs) to assure appropriate reimbursement by payors Assures appropriate reimbursement by payors by comparing actual versus expected medication reimbursement rates Follows-up with Revenue Cycle team on resubmitted drug claims until the accounts are at a zero balance or expected payment is received by payor Serves as an additional resource in the Enterprise Clinical Information System (i.
e.
Cerner Millennium, AllScripts, Epic) pre and post-implementation phases.
Provides support in conducting medication billing audits to ensure that the Pharmacy Chargemaster or other operational changes result in optimum reimbursement.
Provides support in evaluating cost-effectiveness of new formulary additions based on health system payor mix, population demographics and reimbursement rates.
Maintains summary report of all projects submitted including projected reimbursement and recovered revenue.
Ensures medication billing complies with all billing guidelines and/or regulations including Medicare, NJ Medicaid, 340B and commercial payors.
Maintains medication replacement program and billing procedures with affiliate hospitals and vendor Assists in managing account holds and charge reversal processes Resource to affiliate hospitals on workflow process Job Requirements HS Diploma, required.
Associates or Bachelors Degree, preferred.
Min three (3) years of medical coding/billing experience, and a background in business/finance in a health care organization, required OR AN EQUIVALENT COMBINATION OF RELEVANT EDUCATION AND/OR EXPERIENCE Preferred knowledge in fields such as hospital/medical office administration, pharmacy technician, nursing, billing or similar vocations generally obtained through completion of associate s degree program, pharmacy technician certification, or equivalent combination of experience and education.
Minimum Skills, Knowledge and Competency Requirements Prefer pharmacy or healthcare reimbursement experience Prefer hematology/oncology experience; medical/hospital coding, billing, and collections, drug reimbursement Knowledge base of Medicare rules and regulations (NCD/LCD), federal registry, Medicaid, insurance-based prior authorizations and clinical coverage guidelines HCPCS/CPT coding experience preferred High level of curiosity, self-motivation and attention to detail Strong mathematical and analytical skills Ability to work independently with strong organizational skills Ability to communicate effectively both orally and in writing Excellent project management skillsKnowledge of Microsoft Word and Excel required; Microsoft Access and Power Point preferred Additional InformationRWJBarnabas Health is the most comprehensive health care delivery system in New Jersey, with a service area covering five million people.
The system includes eleven acute care hospitals Clara Maass Medical Center in Belleville, Community Medical Center in Toms River, Jersey City Medical Center in Jersey City, Monmouth Medical Center in Long Branch, Monmouth Medical Center Southern Campus in Lakewood, Newark Beth Israel Medical Center in Newark, RWJUH- New Brunswick, RWJUH- Somerset in Somerville, RWJUH- Hamilton, RWJUH- Rahway and Saint Barnabas Medical Center in Livingston; three acute care children s hospitals and a leading pediatric rehabilitation hospital (Children s Specialized Hospital), a freestanding 100-bed behavioral health center, trauma centers, a satellite emergency department, ambulatory care centers, geriatric centers, the state s largest behavioral health network, comprehensive home care and hospice programs, fitness and wellness centers, retail pharmacy services, a medical group, multi-site imaging centers and an accountable care organization.
We offer a great work environment, competitive rates and excellent benefits, including:
Medical/Dental/Vision plans 401 (k) PTO Short & Long Term Disability Basic Life & Accidental Death Insurance Tuition Reimbursement Health Care/Dependent Care Flexible Spending Accounts Equal Opportunity EmployerRWJBarnabas Health is an Equal Opportunity Employer Recommended Skills Analytical Attention To Detail Auditing Cash Management Chargemaster Claim Processing Estimated Salary: $20 to $28 per hour based on qualifications.
The position is part of an interdepartmental collaboration within RWJBarnabas Health and requires frequent interactions with the health system s business office members as well as the local affiliate hospitals.
The departments include, but are not limited to Revenue Cycle, IT&S, pharmacy informatics, pharmacy directors, managed care, compliance, oncology nursing, outpatient infusion and any areas where medications are administered.
The Pharmacy Billing Specialist also partners with Revenue Integrity to increase the accuracy and efficiency of the Pharmacy charge description master (CDM) for the entire health system.
The position objectives are to provide support to Corporate Pharmacy and RWJBarnabas Health and maximize institutional revenue.
Essential Job Functions Researches medication-related insurance claim denials Follows-up on unpaid or underpaid pharmacy claims Ability to complete appeals to insurance payors Monitors and reports outcomes of denials reviews and provides the recommendation for process improvements Communicates denial and billing issues to affiliate sites as necessary Performs technical review for medication formulary requests for Enterprise Clinical Information Systems (ECIS) Pharmacy Informatics & Revenue Integrity teams, include:
CPT/ HCPCS & revenue codes for accuracy & validity All potential modifiers Medication billing units (J-codes) NDC billing data fields Obtains approval for all additions, inactivation s, changes and/or revisions made to the CDM Communicates CDM changes to the appropriate facilities & individuals Reviews all aspects of billing and collections processes (e.
g.
billing, coding, ECIS, collections, contractual adjustments, denials, compliance, etc.
).
Identifies areas of improvement across and within processes Formulates recommendations and assists with implementation of changes Verifies medication charges are documented appropriately in financial, clinical and operational areas (i.
e.
ECIS, medical records, charge forms, itemized bills) Disseminates medication-related regulatory/coding/billing information to internal customers Responds to ad hoc medication billing or reimbursement questions Understands NDC requirements for state Medicaid and Managed Medicaid payors for billing hospital outpatient medications.
Assists in the development of an automated process to comply with NDC requirements Partners with Patient Accounting and Revenue Integrity to ensure denials and billing errors related to the Drug Chargemaster are addressed in a timely and accurate manner.
Analyzes and reviews drug and drug-related billing denials for medical necessity or any other coding specific denial reason.
Reviews Remittance Advice (RAs) and Explanation of Benefits (EOBs) to assure appropriate reimbursement by payors Assures appropriate reimbursement by payors by comparing actual versus expected medication reimbursement rates Follows-up with Revenue Cycle team on resubmitted drug claims until the accounts are at a zero balance or expected payment is received by payor Serves as an additional resource in the Enterprise Clinical Information System (i.
e.
Cerner Millennium, AllScripts, Epic) pre and post-implementation phases.
Provides support in conducting medication billing audits to ensure that the Pharmacy Chargemaster or other operational changes result in optimum reimbursement.
Provides support in evaluating cost-effectiveness of new formulary additions based on health system payor mix, population demographics and reimbursement rates.
Maintains summary report of all projects submitted including projected reimbursement and recovered revenue.
Ensures medication billing complies with all billing guidelines and/or regulations including Medicare, NJ Medicaid, 340B and commercial payors.
Maintains medication replacement program and billing procedures with affiliate hospitals and vendor Assists in managing account holds and charge reversal processes Resource to affiliate hospitals on workflow process Job Requirements HS Diploma, required.
Associates or Bachelors Degree, preferred.
Min three (3) years of medical coding/billing experience, and a background in business/finance in a health care organization, required OR AN EQUIVALENT COMBINATION OF RELEVANT EDUCATION AND/OR EXPERIENCE Preferred knowledge in fields such as hospital/medical office administration, pharmacy technician, nursing, billing or similar vocations generally obtained through completion of associate s degree program, pharmacy technician certification, or equivalent combination of experience and education.
Minimum Skills, Knowledge and Competency Requirements Prefer pharmacy or healthcare reimbursement experience Prefer hematology/oncology experience; medical/hospital coding, billing, and collections, drug reimbursement Knowledge base of Medicare rules and regulations (NCD/LCD), federal registry, Medicaid, insurance-based prior authorizations and clinical coverage guidelines HCPCS/CPT coding experience preferred High level of curiosity, self-motivation and attention to detail Strong mathematical and analytical skills Ability to work independently with strong organizational skills Ability to communicate effectively both orally and in writing Excellent project management skillsKnowledge of Microsoft Word and Excel required; Microsoft Access and Power Point preferred Additional InformationRWJBarnabas Health is the most comprehensive health care delivery system in New Jersey, with a service area covering five million people.
The system includes eleven acute care hospitals Clara Maass Medical Center in Belleville, Community Medical Center in Toms River, Jersey City Medical Center in Jersey City, Monmouth Medical Center in Long Branch, Monmouth Medical Center Southern Campus in Lakewood, Newark Beth Israel Medical Center in Newark, RWJUH- New Brunswick, RWJUH- Somerset in Somerville, RWJUH- Hamilton, RWJUH- Rahway and Saint Barnabas Medical Center in Livingston; three acute care children s hospitals and a leading pediatric rehabilitation hospital (Children s Specialized Hospital), a freestanding 100-bed behavioral health center, trauma centers, a satellite emergency department, ambulatory care centers, geriatric centers, the state s largest behavioral health network, comprehensive home care and hospice programs, fitness and wellness centers, retail pharmacy services, a medical group, multi-site imaging centers and an accountable care organization.
We offer a great work environment, competitive rates and excellent benefits, including:
Medical/Dental/Vision plans 401 (k) PTO Short & Long Term Disability Basic Life & Accidental Death Insurance Tuition Reimbursement Health Care/Dependent Care Flexible Spending Accounts Equal Opportunity EmployerRWJBarnabas Health is an Equal Opportunity Employer Recommended Skills Analytical Attention To Detail Auditing Cash Management Chargemaster Claim Processing Estimated Salary: $20 to $28 per hour based on qualifications.
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