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Pharmacist - Pharmacy Revenue Integrity

Job ID: 7825
Location: Durham, NC
Facility/Division: Shared Services
Status: Full Time
Shift: Day Job

Did you know UNC Health has Ranked #2 Most Trusted Healthcare Brand in the U.S.? The UNC Health brand was ranked as the #4 healthcare brand in the United States overall and the #2 most trusted healthcare brand, just after Johns Hopkins and before Mass General. Join our One-Great-Team!

Job Description


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.

Provides care of patients by optimizing medication use and drug distribution services.

Position Summary:

The Revenue Integrity pharmacist will join the Pharmacy Revenue Integrity (PRI) team, which includes an Operational Project Manager, a Reimbursement Analyst, three Denials Specialists and two Revenue Integrity 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 Revenue Integrity Pharmacist will work with the PRI team to evaluate all the pharmacy claims denials, process discrepancies and identify areas for workflow improvement through routine data analysis using internal databases and key performance indicators. 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 Revenue Integrity pharmacist 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 Revenue Integrity Pharmacist 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.

·Identify, analyze and research frequent root causes of denials and develop corrective action plans for resolution.

·Develop reporting tools that effectively measure and monitor processes throughout the denials management process

·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.

·Provide clinical and pharmacy operational expertise to assist PRI Denials Specialists in overturning denials

·Research, respond and document insurer and patient correspondence / inquiry notes regarding coding coverage, benefits and reimbursement on patient accounts.

·Collaborate with the pharmacy pre-certification team in quality improvement initiatives.

·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.

·Compile, analyze, and report on the financial performance of departmental operating units.

·Maintain a current knowledge of payor and regulatory guidelines for medical insurance claims processing and reimbursement.

·Participate in departmental lean quality events.

·Participate in departmental and hospital committees.

Skills and Attributes:

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

·Demonstrated understanding of medical terminology required

·Knowledge of CPT, HCPCS, and ICD10 coding

·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 PGY1 and/or PGY2 residency

·Demonstrated proficiency with EPIC Healthcare software

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

    Other Information

    Other information:
    Education Requirements:
    ● Bachelor's degree in Pharmacy.
    Licensure/Certification Requirements:
    ● Eligible for licensure as a Registered Pharmacist in NC. Licensure from NC Board of Pharmacy required within 6 months of orientation date or sooner if required for operations.
    Professional Experience Requirements:
    ● No prior experience required.
    Knowledge/Skills/and Abilities Requirements:

    Job Details

    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:Durham

    Exempt From Overtime: Exempt: Yes

    This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care. This is not a State employed position.
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    Diversity Statement

    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.

    Equal Employment Opportunity

    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.

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