Billings Clinic Pharmacy Charge Analyst - Specialty Pharmacy in Billings, Montana
Job Description: You can make a difference as a part of our region's largest health care system, based locally in Billings, Montana. Join our amazing team with a focus on safe, high quality care and an excellent patient experience. Billings Clinic is here to take care of our community and region. We look forward to meeting you. About Us Billings Clinic is a community-owned, not-for-profit, Physician-led health system based in Billings with more than 4,700 employees, including over 550 physicians and non-physician providers. Our integrated organization consists of a multi-specialty group practice and a 304-bed hospital. Learn more about Billings Clinic (our organization, history, mission, leadership and regional locations) and how we are recognized nationally for our exceptional quality. Your Benefits We provide a comprehensive and competitive benefits packa ge to all full-time employees (minimum of 24 hours/week), including Medical, Dental, Vision, 403(b) Retirement Plan with employer matching, Defined Contribution Pension Plan, Paid Time Off, employee wellness program, and much more. Click here for more information or download the 2021 Employee Benefits Guide. Magnet: Commitment to Nu rsing Excellence Billings Clinic is proud to be recognized for nursing excellence as a Magnet?-designated organization, joining only 97 other organizations worldwide that have achieved this honor four times. The re-designation process happens every four years. Click here to learn more! Pharmacy Cha rge Analyst - Specialty Pharmacy SPECIALTY PHARMACY (Specialty Pharmacy) req1827 Shift: Day Schedule: Mon-Fri Employment Status: Full-Time (.75 or greater) Hours per Pay Period: 1.00 = 80 hours(Non-Exempt) Starting Wage DOE: CUSTOM.POSTING.WAGE Serves as the primary focal point and charge analyst for all billing related activities in the Pharmacy Departmen t. The position is responsible for researching and remaining informed on pharmacy compliance regulations, laws, and guidelines as they relate to billing. The Pharmacy Charge Analyst works closely with Pharmacy Leadership and related internal departments such as Patient Financial Services and Accounting to ensure billing guidelines are adhered to and high-risk areas are identified and addressed. Position is responsible to review, analyze, and interpret regulations and standards for appropriate charging, to ensure adherence to third party payer regulations and standards, to monitor reimbursement for medications administered and place charge-process standards into practice. Provides billing and reimbursement training and education to pharmacists and technicians, communicates charging and documentation requirements, and conducts regular audits of charge practices and reimbursement throughout the organization. Provides documentation to Department Mana gers; makes recommendations, when appropriate, and/or revises procedures as needed. Essential Job Functions • Supports and models behaviors consistent with Billings Clinic’s mission, vision, values, code of business conduct and service expectations. Meets all mandatory organizational and departmental requirements. Maintains competency in all organizational, departmental and outside agency standards as it relates to the environment, employee, patient safety or job performance. • Develops and implements a system to solicit, evaluate, and respond to complaints and concerns relating to medication charges or billing issues from any Billings Clinic department, person, or employee. Investigates and acts on matters related to billing/charges, responding to inquiries for clarification or verification of charges and/or billing processes. • Participates in the regular review and audit of medication charges. • Audits patient’s medical records versus the dispensing and/or administration record to ensure all medications are billed in accordance with Billings Clinic charging policies. Communicates audit results and makes recommendations to Pharmacy Leadership. Revises and/or reinforces procedures when indicated, to obtain the desired result. • Researches, analyzes and resolves situations in which inappropriate payment (low or none) has been received from payers. Challenges inaccurate payments made when posting “explanation of benefits” and remittance advises to maximize reimbursement. Corrects and reprocesses bills, if appropriate. • Assists in the production of monitoring reports from the charge/ billing systems across the organization. Assumes ownership role in responsibility for success of analytics and ad hoc reporting. • Charges interdepartmental medications, assigns the natural classes, and appropriates charges to the correct journal acco unt. Reviews, revises, and continuously improves cost accounting processes between departments. Provides department managers with current usage and cost reports of stocked medications. • Acts as a resource and liaison for external audits and communications related to compliance issues with various departments such as: Decision Support, Information Services, Patient Financial Services, Compliance, and Risk Management. • Manual pricing of nonformulary medications. Includes the review and research associated with the pricing and utilization of non-formulary medications. • Responsible for the reporting and ana lysis of all retail pharmacy performance and relaying that information to accounting for proper recording of revenues. Presents findings to Pharmacy Leadership on a regular basis. • Performs other duties as assigned or needed to meet the needs of the department/organization. Knowledge, Skills, and Abilities • Billings Clinic policies and procedures, both organizational and departmental • Personal computers, hardware and software including Microsoft Office (Excel, Word), Cerner, AS400, Lawson, Retail Pharmacy Systems • The interaction between multiple software charge/billing systems • Pharmaceutical terminology • Pharmacy services and practices • Regulatory standards and guidelines as they pertain to pharmaceutical services (JCAHO, OSHA, FDA, etc.) • HIPAA Confidentiality requirements • Billings Clinic Code of Business Conduct • Patient’s/resident’s rights • Federal and third-party insurance billing requirements, coding practices, regulations and reimbursement methodologies and collection functions • Office procedures, record and bookkeeping practices • Customer service and Personal Service Excellence (PSE) skills and techniques • Quality and process improvement principles and tools • Code of Business Conduct • Professional communication skills, both verbal and written • Analytical and critical thinking to assist with problem avoidance/resolution and process improvement • Data analysis and accurate report writing to support corporate compliance and process improvement activities • Time management, organization, and prioritization • Microsoft Office Programs (i.e. Word, Excel, and Access) • Utilizing personal computer systems and understanding the interaction between multiple software systems • Facilitating change management • Basic typing • Basic 10-key • Conflict resolution • Interpersonal relationships; facilitate group dynamics, create enthusiasm and encourage teamwork among diverse members of a group • Incorporate cultural diversity and age-appropriate care into all aspects of communication and patient care; scope of services provided will encompass age groups ranging from infant through geriatric • Communicate clearly and effectively, both verbal and written • Understand complex federal and state coding and billing requirements • Establish and maintain collaborative relationships • Concentrate and pay close attention to detail • Maintain flexibility to adapt to a variety of workload assignments • Work effectively in a team environment • Work independently with minimal supervision • Respond calmly and effectively in emergent situations • Balance multiple priorities and to maintain flexibility to adapt to a variety of workload assignments • Utilize time management concepts and maximize time effectively • Interpret policies and procedures, identify non-compliance and take appropriate action • Work with numbers and perform basic to complex mathematics • Research and analyze insurance claim remittance and correspondence and document procedures • Identify and resolve charge code problems. Effectively monitor and evaluate all charging systems and demonstrate good judgement in any corrective action necessary. Maintain documentation of changes for purposes of tracking process improvement. Process meaningful reports that reflect best use of data, statistical analysis and trending. • Exhibit good judgment and unquestionable ethics in handling sensitive and confidential information< /span> • Work supportively with multiple professional, managerial and administrative staff to maintain adherence to policies and procedures. Respond verbally and/or in writing to immediate requests and project a personal demeanor that conveys integrity, confidence, sincerity and competency. Listen and appropriately respond to complaints, concerns and occasional inappropriate behavior in an effective, timely, ethical and polite manner. • Provide visionary thinking and processes which may be outside the traditional methods and standards • Position requires the highest degree of integrity and confidentiality due to the sensitive nature of information handled. The Pharmacy Charge Analyst is delegated the authority necessary to independently investigate and review all documents and other information (i.e., requisition forms, billing information, claim information, medical records, etc.) relating to billing/charging activities and to act on such matters • Position requires the ability to demonstrate high levels of integrity, good judgment, assertiveness and an approachable demeanor, while eliciting the respect and trust of employees and Leadership • Pharmacy Charge Analyst acts independently with minimal supervision and direction from the Pharmacy Leadership Team. Position must be able to develop and direct systems to facilitate Pharmacy’s ability to be in compliance with regulatory, legal and accreditation requirements as it relates to billing/charges. • Coordination and communication are the key functions of the Pharmacy Charge Analyst with regard to planning, implementing and monitoring the pharmacy billing/charge programs. • Decisions regarding drug charging and reimbursement may have legal, financial and customer service implications. Errors could result in inaccurate patient statements or changes that could result in a loss of revenue, physician and/or patient complaints. • Develops measurement processes and reports that are of seriou s importance to the organization. The position is responsible for decisions that impact employees, visitors, patient/resident safety, insurance coverage, financial loss, accreditation status, reimbursement, and/or legal outcomes. Accuracy and data collection is critical in determining correct reimbursement for services. • Review HCFA and other third-party compliance issues so Billings Clinic can maintain good governmental and third-party provider relationships Minimum Qualifications Education •Two years post high school education Experience • Two years of work experience with patient a ccounting, auditing, cost accounting, and/or ledger billing • Two years’ experience in a multi-specialty clinic working with ICD-10, CPT-4/HCPCS coding, preferred Licensure and Certification • Within 1 year of hire - Certified Pharmacy Technician (or ability to obtain certification within 12 months of hire) Other Minimum Qualifications • Previous experience with Excel, Word, Cerner EMR, Cerner Rev Cycle, AS400, Lawson, preferred • Demonstrated ability to understand and develop complex spreadsheets • Or an equivalent combination of education and experience relating to the above tasks, knowledge, skills and abilities will be considered Billings Clinic is Montana’s largest health system serving Montana, Wyoming and the western Dakotas. A not-for-profit organization led by a physician CEO, the health system is governed by a board of community members, nurses and physicians. Billings Clinic includes an integrated multi-specialty group practice, tertiary care hospital and trauma center, based in Billings, Montana. Learn more atwww.billingsclinic.com/aboutus Billings Clinic is committed to being an inclusive and welcoming employer, that strives to be kind, safe, and courageous in all we do. As an equal opportunity employer, our policies and processes are designed to achieve fair and equitable treatment of all employees and job applicants. All employees and job applicants will be provided the same treatment in all aspects of the employment relationship, regardless of race, color, religion, sex, gender identity and expression, sexual orientation, pregnancy and family status, national origin, spoken language, neurodiversity, age, and/or disability. To ensure we provide an accessible candidate experience for prospective employees, please let us know if you need any accommodations during the recruitment process.