Analysis Skills, Billing, Certified Coding Specialist (CCS), Certified Professional Coder (CPC), Detail Oriented, Documentation, Federal Laws and Regulations, Healthcare, Healthcare Common Procedure Coding System (HCPCS), Healthcare Reimbursement, ICD-10, International Classification of Diseases (ICD), Maintain Compliance, Managed Care, Outpatient Care, Patient Care, Pharmacy, Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Regulatory Compliance, Reimbursement, Revenue Analysis, Value Analysis, Work From Home
Responsibilities
The Sr. Revenue Integrity Pharmacy Analyst is responsible for expert review of pharmacy related charge audits, denials, quarterly HCPCS updates, and value analysis. They will review and analyze pharmacy claims, collaborating with pharmacy IS, Billing and Managed Care to ensure compliance with billing regulations while maximizing reimbursement. Additionally they provide support and education to Pharmacy and Revenue Cycle teams on coding and documentation requirements. Strong attention to detail with extensive knowledge in Pharmacy billing, coding, payor policies, federal regulations and reimbursement methodologies are essential for this role.
This position offers a fully remote work opportunity. Employees in this role must reside in one of the following states to be considered for fully remote positions: Kentucky, Indiana, Missouri, Ohio, Tennessee, Alabama, Virginia, Mississippi, North Carolina, South Carolina
Qualifications
Required:
- Three years of experience in healthcare revenue cycle, clinic operations or pharmacy technician
- (Within one year of hire) One of: CCA or CCS or CIC-ICD or COC or CPC or RHIA or RHIT
Desired:
- Certified Coding Associate OR Certified Coding Specialist OR Certified Professional Coder OR Registered Health Information Administrator OR Registered Health Information Technician OR Certified Outpatient Coding OR Certified Inpatient Coder ICD-10
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Norton Healthcare Foundation