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CHARGE INTEGRITY ANALYST

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Job Description

Position:  Charge Integrity Analyst

Location:  Lenovo Building / Morrisville

Hours:  Full Time, 40 hrs/wk; Days


Position Summary:


The Charge Integrity Analyst will join the Pharmacy Revenue Integrity team, which includes Reimbursement Analysts, Charge Integrity Analysts, and a clinical pharmacist.  The PRI team works with the Pharmacy Medication Assistance Program (MAP) team, the Epic Willow team, Pharmacy Analytics, the Pharmacy Business Office, and the various pharmacy clinical and operational area teams, in addition to developing and sustaining communication channels with the Revenue Cycle, Patient Financial Services, Hospital Billing, Managed Care, and Health Information Management departments to ensure clarity, consistency and accuracy around the pharmacy charge, reimbursement and revenue cycle.

The Charge Integrity Analyst will proactively maintain specific payor work-queues related to denials, researching payor coverage policies and appeal requirements, auditing patient account histories, and submitting required documentation to payors. Best practices in pharmacy denials management will be identified and developed to ensure the department is fiscally responsible and compliant with all commercial, state and federal regulations.  The Charge Integrity Analyst will also assist in data analyses, third party reporting, and routine auditing. 

The Charge Integrity Analyst will provide regular updates to executive and pharmacy leadership through area assessments and compliance improvement recommendations.  A dashboard summary of payor denial work queues and recommendations will be presented to Pharmacy leadership and appropriate UNC Medical Center/Health Care System committees.   


Key Responsibilities:


The responsibilities of the Charge Integrity Analyst include, but are not limited to, the following:

  • Proactively maintain specific payor denial work queues, researching payor coverage policies and appeal requirements, auditing patient account histories, and submitting required documentation to payors.

  • Act as a pharmacy denials and charge integrity business expert and revenue cycle liaison.

  • Lead chart audits and conduct internal audits of claims and payment to assure that uncompensated patient revenues resulting from denials of patient service billings are minimized.

  • Review departmental charge capture procedures. Annually review procedures, and ensure updates have been added. Maintain a copy of all procedures. Perform random department audits to ensure they are following their procedures.

  • Analyze and coordinate electronic data files within the department and ensure missed charges are billed.  Create and submit quarterly reports to monitor the impact of missed revenue and the outcome of revenue posted. Submit recommendations and assist the department with corrective action plans.

  • Assist with and audit end-to-end pharmacy reimbursement and revenue cycle analysis to uncover pharmacy financial discrepancies and revenue loss due to coding errors and incorrect Charge Data Master mapping.  Coordinate activities to make charge corrections. Perform periodic audits to ensure appropriate charging of services based on medical documentation. Compile reports and submit findings and recommendations to department leadership.

  • Proactively maintain NDC updates in electronic medical record.

  • Develop and sustain routine communication channels with the billing, finance, accounting, and Health Information Management departments and clarity, consistency and accuracy around the pharmacy reimbursement and revenue cycle.
  • Develop a performance improvement plan that will record and trend high dollar charges and denials.
  • Prepare financial/regulatory/quality analysis reports for departmental leadership and staff.
  • Utilize internal and external software to identify denied and/or corrected claims for payment.
  • Compile, analyze, and report on the financial performance of departmental operating units.
  • Initiate, extract, and analyze data elements to identify potential performance improvement and cost savings initiatives.
  • Participate in departmental lean quality events
  • Participate in departmental and hospital committees

Skills and Attributes:

The Pharmacy Charge Integrity Analyst should demonstrate or be willing to learn the following skills and attributes:

  • Hospital billing (CPT/HCPCS/Revenue Codes), CDM drugmaster maintenance (eRX), and patient accounts

  • Demonstrated understanding of medical terminology required

  • Knowledge of patient confidentiality and HIPAA regulations

  • Knowledge of medical billing and collection practices

  • Understanding of Medicare and Medical Assistance regulations as they apply to job functions

  • Knowledge working with electronic health records (EHR/EMR) or healthcare related computer systems

  • Excellent written and verbal skills are required as well as outstanding interpersonal skills

  • Efficient methods for getting work done; strong ability to prioritize workload

  • Organized; sets priorities; meets deadlines

  • Ability to work independently


Preferred Experience:
  • Experience in finance, insurance, insurance appeals, medication and medical terminology required.

  • Masters Degree in Business and experience in a healthcare setting or physician’s practice preferred.

  • Ability to work in self-directed manner while interacting with patients, prescribers and all medical center faculty and staff.

  • Ability to communicate clearly with health care team.

  • Strong demonstrated communication skills.

  • Experience with Windows, Excel, PowerPoint, Business Objects, or other financial/analytical software.

  • Must be highly organized, detail-oriented, and able to manage multiple projects at a time.


Qualifications

Bachelor's degree in an appropriate discipline (or equivalent combination of education, training and experience). 


If a Bachelor's degree: Three (3) years of experience in a hospital setting with knowledge of Medicare billing and experience interpreting government regulations. 

If an Associate's degree: Seven (7) years of experience in a hospital setting with knowledge of Medicare billing and experience interpreting government regulations. 

If a High School diploma or GED: Eleven (11) years of experience in a hospital setting with knowledge of Medicare billing and experience interpreting government regulations.

Primary Location: Morrisville, North Carolina, United States

Department: SHRD-72702-PHARMACY BUSINESS OFFICE

Shift: Day Job

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