Pharmacy Accounts Auditor - Hybrid

Advocate Aurora Health; Georgia; Hybrid; USD 53,000 - 79,000; Full time

Benefits offered by this job

Health benefits

PTO

FSA

Parental leave

Retirement plan

Educational assistance

Job summary

Advocate Health seeks a Pharmacy Billing Auditor to plan and perform charge capture reviews, ensuring accurate CPT/HCPCS coding and proper revenue capture. You will collaborate with internal customers and external partners to optimize billing practices and prepare reports detailing findings and recommendations.

The role requires two years of billing systems experience (EPIC/Encompass), strong communication, and a solid understanding of HIPAA regulations.

Qualifications

• College degree or an equivalent combination of education and/or experience required.
• Two years’ experience with billing systems such as EPIC/Encompass preferred.
• Strong communication and analytical skills with attention to detail.

Responsibilities

• Plans and performs charge capture reviews to ensure accurate billing.
• Collaborates with internal/external stakeholders on billing and coding to optimize revenue capture.
• Develops written reports documenting review findings and recommendations.
• Prepares management reports and executive summaries of review results.

Skills

Communication skills

Attention to detail

Problem solving

MS Office

Education

College degree or equivalent

Tools

EPIC

Encompass

Job description

Department: 38410 Navicent Health Medical Center - Pharmacy

Status

Full time

Benefits Eligible

Yes

Hours Per Week

40

Schedule Details/Additional Information

• Monday - Friday, no weekends or holidays
• 7:00 AM - 3:00 PM
• This is a hybrid role (onsite and work from home when appropriate for business needs.)

Pay Range

$25.30 - $37.95

Job Summary

Plans and performs charge capture reviews in accordance with proper billing practices. Collaborates with internal and external customers on billing and coding functions to determine billing accuracy and optimize revenue capture. Develops written reports documenting review findings and recommendations.

Major Responsibilities

• 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
• Recommends new policies, procedures, and strategies to streamline workflows and ensure department is meeting organizational objectives and goals
• Documents and/or reviews all data collected during the review, identifying all billing, coding, and documentation errors
• Reviews HCPCS and coding updates, as applicable
• 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 departmental staff
• Verifies the validity of data/reports used and generated and adheres to system policies and procedures
• Follows through to ensure that any critical corrective action is taken and evaluates efficiency of interventionsPrepares management reports, spreadsheets, and executive summaries of review findings
• Plans scope of review and communicates plan with leadership

Licensure, Registration, and/or Certification Required

• Pharmacy Technician registration with Georgia state board of pharmacy per state of employment requirements.
• PTCB or ExCPT certification.

Education Required

• College degree or an equivalent combination of relevant education and/or experience required.

Experience Required

• Typically two years' experience with or exposure to relevant billing systems i.e. EPIC/Encompass.
• Auditing and purchasing experience.

Knowledge, Skills & Abilities Required

• Highly effective communication (written and verbal) and interpersonal skills
• Exceptional customer service, problem resolution and process development skills
• Demonstrated leadership skills such as delegation, team building, managing multiple priorities, problem solving, and decision making
• Ability to understand and become knowledgeable of pharmacy standards, policies, procedures, and Health Insurance Portability and Accountability Act (HIPAA) regulations
• Demonstrated ability to maintain confidentiality, take imitative, and to work independently with minimal supervision
• Must be detail-oriented with the ability to handle multiple demands simultaneously
• Basic math skills
• Strong background in medical terminology preferred
• Organizational skills and analytical ability to prepare reports and reconcile reports correctly
• Computer skills with Microsoft Office, email, internet access, electronic pharmacy management systems, and pharmacy ordering and inventory systems
• Life support training courses may be required dependent on department discretion

Physical Requirements and Working Conditions

• Generally exposed to normal clinic office environment
• Must be able to sit, stand, walk, lift, bend, kneel, climb, twist, crawl and reach above shoulders. May require extended periods of sitting.
• Must be able to stand up majority of the workday
• Must be able to bend adequately to occasionally lift, move, pack and unpack boxes
• Must be able to:
• Lift up to 15 lbs. from floor to overhead
• Lift up to 40 lbs. from floor to waist
• Lift and carry up to 40 lbs. at waist height at a reasonable distance
• Push/pull with 20 lbs. of force
• Flexibility to travel between pharmacy locationsOperates all equipment necessary to perform the job
• Must have functional vision, touch and hearing
• Must be able to speak and be understood by others to communicate effectively
• Must be able to perform manipulative skills such as writing, typing, and data entry into the computer system

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

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

Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview.

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.