Pharmacy Accounts Auditor - Hybrid

Atrium Health; Macon (GA); On-site; USD 60,000 - 80,000; Full time

Job summary

Atrium Health is seeking a Pharmacy Charge Capture Auditor to review charge capture practices and collaborate with billing and coding teams to determine billing accuracy and optimize revenue capture. The role emphasizes cross-functional communication and documentation of findings.

You will develop reports, summaries, and training materials; monitor adherence to CPT/HCPCS updates, HIPAA rules, and department policies, while supporting leadership and improving workflows across multiple pharmacy

Qualifications

• Typically two years’ experience with or exposure to billing systems such as EPIC/Encompass.
• Auditing and purchasing experience.
• Familiarity with pharmacy terminology and billing compliance.

Responsibilities

• Maintains knowledge of coding, charge capture, and billing compliance in healthcare.
• Serves as a resource for managers and staff on guidelines and standards.
• Recommends policies to streamline workflows and meet organizational goals.
• Documents data collected during reviews and identifies billing errors.
• Reviews HCPCS and coding updates as applicable.
• Reviews clinical documentation to ensure correct CPT/HCPCS codes and reimbursement.
• Develops educational programs for departmental staff based on findings.
• Prepares management reports and executive summaries of findings.
• Plans scope of review and communicates plans with leadership.

Skills

Billing knowledge

Auditing

EPIC/Encompass

Pharmacy terminology

Communication skills

Leadership

Problem solving

Microsoft Office

Education

College degree

Pharmacy Technician registration

PTCB or ExCPT certification

Tools

EPIC/Encompass

Microsoft Office

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.

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.