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Job ID: 29849
Location: Morrisville, NC
Facility/Division: Shared Services
Status: Full Time
Shift: Day Job
Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.
The Pharmacy Denials Specialist will join the Pharmacy Revenue Integrity (PRI) team, which includes Denials Specialists, a Reimbursement Analyst, a Charge Integrity Analyst, and clinical pharmacists. 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 Denials Specialist will proactively maintain specific payer work queues related to denials, researching payer coverage policies and appeal requirements, auditing patient account histories, and submitting required documentation to payers. 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 Denials Specialist will also assist in data analyses, third party reporting, and routine auditing. The Denials Specialist will provide regular updates to executive and pharmacy leadership through area assessments and compliance improvement recommendations. A dashboard summary of payer denial work queues and recommendations will be presented to pharmacy leadership and appropriate committees.
The Denials Specialist will report directly to the Assistant Director of Pharmacy for the Medication Assistance Program and Pharmacy Revenue Integrity. The position is remote with on-site office space available in Morrisville, NC as needed or preferred.
The responsibilities of the Denials Specialist include, but are not limited to, the following:
Skills and Attributes:
The Pharmacy Denials Specialist should demonstrate or be willing to learn the following skills and attributes:
● Bachelor’s degree in an appropriate discipline.
● No licensure or certification required.
Professional Experience Requirements:
● No experience is required.
● If Associates Degree: Four (4) years of experience in quality team facilitation, project management, process improvement or quality data analysis.
Knowledge/Skills/and Abilities Requirements:
● Strong team facilitation, project management, process improvement, data analysis, quality assurance skills.
Legal Employer: NCHEALTH
Entity: Shared Services
Organization Unit: Pharm Revenue Integrity Progrm
Work Type: Full Time
Standard Hours Per Week: 40.00
Work Schedule: Day Job
Location of Job: US:NC:Morrisville
Exempt From Overtime: Exempt: Yes
The UNC Health System and the UNC School of Medicine are committed to valuing all people throughout our organization, regardless of background, lifestyle, and culture. A diverse and inclusive work environment for staff and culturally appropriate care for our patients, are essential to fulfilling our UNC Health vision of improving the health of all North Carolinians.
UNC Health is an equal opportunity employer. As such, UNC Health offers equal employment opportunities to applicants and employees without regard to race, color, religion, sex, national origin, age, genetic information, disability, sexual orientation, gender identity or political affiliation.