Pharmacy Reimbursement Specialist

UCHealth University of Colorado Health; Fort Collins (CO); On-site; USD 38,000 - 57,000; Full time

Benefits offered by this job

Performance bonus program

Annual merit pay increase

Tuition assistance

Job summary

UCHealth University of Colorado Health is seeking a Pharmacy Billing Specialist to maximize reimbursement and manage accounts receivable in Fort Collins. The role focuses on accurate coding, diligent review of hospital billing, and proactive collaboration with payors and care teams to resolve issues.

The position is onsite, full-time, with a schedule of days and a pay range reflecting experience in hospital billing. Training and benefits are part of UCHealth's comprehensive program.

Qualifications

• High School diploma or GED required.
• Experience in hospital billing preferred.
• Knowledge of CMS, Vitalware, Crosswalks and EPIC coding systems preferred.

Responsibilities

• Review hospital accounts for billing accuracy including codes.
• Review pharmacy billing rejections and issues.
• Collaborate to resolve billing and insurance claim issues by researching coding requirements and payor rules.
• Perform regular AR reporting and analysis to monitor accounts receivable.
• Assist in obtaining documentation of medical necessity for drug therapies.

Education

High School diploma or GED

Tools

CMS coding systems

Vitalware

Crosswalks

EPIC

Job description

Description

Location: UCHealth UCHlth Poudre Valley Hospital, US:CO:Fort Collins

Department: UCHlth Pharmacy Administration

Work Schedule: Full Time, 80.00 hours per pay period (2 weeks)

Shift: Days

Pay: $27.61 - $41.41 / hour. Pay is dependent on applicant's relevant experience

This position is an onsite role and does not offer a hybrid or remote option

Summary: Works collaboratively to maximize pharmacy reimbursement and manage accounts receivable.

Responsibilities

• Reviews hospital accounts for accuracy, including procedure and HCPCS codes.
• Reviews pharmacy related hospital billing rejections and issues.
• Works collaboratively to resolve customer billing/account issues and rejected insurance claims by researching billing/coding issues, reviewing third-party reimbursement requirements, and communicating with payors as necessary.
• Performs regular reporting and analysis to monitor accounts receivables. Serves as a resource on internal and external pharmacy reimbursement practices, policies and requirements, including applicable coding requirements and Medicare, Medicaid and private insurance plan information.
• Serves as a patient/physician advocate for the purpose of securing insurance authorization and benefits for drug therapies, including obtaining documentation ofmedical necessity. Ensurespatient, coding, and billing information is properly entered into appropriate application(s).
• Works with pharmacy and patient accounts staff to identify opportunities for process/quality improvement in billing and reimbursement practices.
• Within scope of job, requires critical thinking skills, decisive judgement and the ability to work with minimal supervision. Must be able to work in a fast-paced environment and take appropriate action.

Requirements

• High School diploma or GED.

Preferred

• Experience in hospital billing.
• Knowledge of industry-specific coding systems and regulations (CMS, Vitalware, Crosswalks, EPIC).

Employees are our number one asset.

UCHealth promotes a culture that invests in professional success and personal well-being through a comprehensive total rewards program. *

Recognition

• Performance bonus: UCHealth offers a 3-Year Incentive Bonus to recognize employee contributions to our success in quality, patient experience, organizational growth, financial goals and tenure. The bonus accumulates annually each October and is paid out in October during the third year of employment.
• Performance-based pay increase: The Annual Merit Pay Increase recognizes work performance that meets or consistently exceeds performance standards documented through UCHealth's established evaluation process and accounts for increased experience, skills and cost of living.
• Market reviews: All UCHealth positions are reviewed annually to ensure UCHealth base pay aligns with market standards. Base pay rates are adjusted as needed to stay market competitive.

Health and well-being

• Medical, dental and vision coverage.
• Access to 24/7 mental health and well-being support for employees and dependents.
• Discounted gym memberships and fitness resources.
• Free Care.com membership.
• Voluntary benefits such as accident insurance, critical illness insurance, group legal plan, identity theft protection, pet insurance, auto and home insurance, and employee discount programs.
• Time away from work: Paid time off (PTO), paid family and medical leave (inclusive of Colorado FAMLI), leaves of absence.
• Employer-provided basic life and accidental death and dismemberment coverage with buy-up coverage options.
• Employer-provided short-term disability and long-term disability with a buy-up coverage option.

Retirement and savings

• 403(b) plan with employer matching contribution.
• Additional 457(b) plan may be available.
• Flexible spending accounts for health care and dependent day care; health savings account available when enrolled in high-deductible (HD) medical plan.

Education and career growth

• UCHealth provides access to academic degrees and certificate programs to promote professional and personal growth.
• • Up to 100% of tuition, books and fees paid for by UCHealth for specific educational degrees.
  • Other programs may qualify for up to $10,000/year pre-paid by UCHealth or up to $5,250/year in the form of tuition reimbursement.
• Access to LinkedIn Learning, which offers thousands of virtual courses and seminars, and internal professional development opportunities.
• Employees have access to free assistance navigating the Public Service Loan Forgiveness program and submitting their federal student loans for forgiveness.

*Eligibility for some programs is based on an employee's scheduled work hours.

We improve lives. In big ways through learning, healing, and discovery. In small, personal ways through human connection. But in all ways, we improve lives.

UCHealth always welcomes talent. This position will be open for a minimum of three days and until a top applicant is identified.

UCHealth recognizes and appreciates the rich array of talents and perspectives that equal employment and diversity can offer our institution. As an equal opportunity employer, UCHealth is committed to making all employment decisions based on valid requirements. No applicant shall be discriminated against in any terms, conditions or privileges of employment or otherwise be discriminated against because of the individual's race, color, national origin, language, culture, ethnicity, age, religion, sex, disability, sexual orientation, gender, veteran status, socioeconomic status, or any other characteristic prohibited by federal, state, or local law. UCHealth does not discriminate against any qualified applicant with a disability as defined under the Americans with Disabilities Act and will make reasonable accommodations, when the do not impose an undue hardship on the organization.

Who We Are (uchealth.org)