Pharmacy Accounts Auditor - Hybrid

Advocate Health; Macon (GA); On-site; USD 52,000 - 66,000; Full time

Job summary

Advocate Health is seeking a detail‑oriented professional to plan and perform charge capture reviews, ensuring proper billing practices and accurate reimbursement. You will collaborate with internal and external customers to optimize revenue capture and document findings with recommendations.

The role requires knowledge of coding, billing guidelines, and HIPAA regulations, along with experience in EPIC/Encompass and related systems.

Qualifications

• Two years’ experience with billing systems (EPIC/Encompass) preferred.
• Pharmacy, billing, or auditing background beneficial.
• Strong communication and analytical skills.
• Strong communication and analytical skills.
• HIPAA knowledge and confidentiality required.

Responsibilities

• Maintains knowledge of coding, charge capture, and billing compliance in healthcare.
• Serves as a resource for guidelines and regulatory standards of coding and billing.
• Documents and reviews data collected during reviews, identifying billing and documentation errors.
• Reviews HCPCS and coding updates; ensures accurate CPT/HCPCS coding and reimbursement.
• Develops educational and training programs for departmental staff.
• Prepares management reports, spreadsheets, and executive summaries of review findings.
• Plans scope of review and communicates plan with leadership.
• Plans scope of review and communicates plan with leadership.

Skills

Communication skills

Interpersonal skills

Detail oriented

Problem solving

Medical terminology

HIPAA knowledge

Team collaboration

Documentation

Organizational skills

Analytical ability

Computer skills

Education

College degree

Pharmacy Technician registration

PTCB or ExCPT certification

Tools

EPIC/Encompass

Microsoft Office

Pharmacy management systems

Job description

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 interventions
• Prepares 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 locations
• Operates 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.