Travel Pharmacy Billing Compliance Specialist

Adventist Health; Roseville (CA); On-site; USD 105,000 - 113,000; Full time

Job summary

Adventist Health in Roseville, CA seeks a Pharmacy Billing Compliance Specialist to ensure accurate charging, billing, and reimbursement across outpatient hospital departments, compliant with CMS, HRSA, and payer guidelines.

Responsibilities include reviewing charges, validating NDC to HCPCS mappings, ensuring 340B and WAC policies, auditing, and correcting charge capture before submission.

Qualifications

• High School Education/GED or equivalent; Associate's/Technical Degree or relevant experience preferred.
• Minimum of three years' experience in pharmacy, revenue integrity, billing, or compliance is required.
• Experience with EMR/billing systems (Epic Resolute, Cerner) preferred.
• Current State Pharmacy Technician license is required (CA, OR, &/or HI).
• Pharmaceutical Technician Board certification preferred.
• Advanced certification such as CHRI, CRCR, or 340B ACE preferred.

Responsibilities

• Review and reconcile medication charges in outpatient hospital encounters.
• Validate NDC to HCPCS mapping, billable units, and modifiers per CMS and payer rules.
• Ensure compliance with 340B, GPO, and WAC pricing; collaborate with 340B teams.
• Participate in CMS, HRSA, and payer audits.
• Identify and correct charge capture errors prior to billing.
• Monitor UB-04 claim accuracy for outpatient medication billing.

Skills

Attention to detail

Compliance

Audit knowledge

Education

Associate's/Technical Degree or relevant experience

Tools

Epic Resolute

Cerner Revenue Cycle

Job description

Adventist Health in Roseville, CA seeks a Pharmacy Billing Compliance Specialist to ensure accurate charging, billing, and reimbursement across outpatient hospital departments, compliant with CMS, HRSA, and payer guidelines.

Responsibilities include reviewing charges, validating NDC to HCPCS mappings, ensuring 340B and WAC policies, auditing, and correcting charge capture before submission.