Pharmacy Charge Specialist

Requisition Number: 11967

Position Title:

External Description:

Nuvance Health has a network of convenient hospital and outpatient locations — Danbury Hospital, New Milford Hospital, Norwalk Hospital and Sharon Hospital in Connecticut, and Northern Dutchess Hospital, Putnam Hospital Center and Vassar Brothers Medical Center in New York — plus multiple primary and specialty care physician practices locations, including The Heart Center, a leading provider of cardiology care, and two urgent care offices. Non-acute care is offered through various affiliates, including the Thompson House for rehabilitation and skilled nursing services, and the Home Care organizations.

Summary:

The Pharmacy Charge Specialist position is responsible for providing analytical support in all areas of pharmacy-related charges and revenue. Responsible for the oversight and maintenance of the Pharmacy CDM and related ancillary systems content according to government and third party payer regulations and guidelines. Monitors regulatory changes and payer requirements. Works closely with all revenue-producing areas to ensure accurate and compliant pharmacy charge capture

Responsibilities:

Responsibilities & Qualifications include:

 Monitors and responds to billing issues identified in the Cerner Patient Accounting application

 Daily monitoring of the Cerner Pending Queue (Pending charges comprise medication orders that are administered differently than ordered, as well as intermittent and continuous orders that are administered without having products assigned).

 Investigates and corrects excessive billing unit claims

 Reviews and corrects all rejected charges that occur

 Monitors and reviews the daily JW modifier approval report. If items are identified to be rejected from the report, then this person will be responsible for the appropriate crediting and rebilling of the medication in question

 Coordinates CDM maintenance with the appropriate Revenue Integrity analyst. This would be in conjunction with the formulary review, utilizing the Atlantis Tool

 Conduct annual review of reimbursement codes (JCODES) and update the formulary accordingly

 Keeps current with Pharmacy Billing Regulations for compliance

 Assist in investigating and responding to Billing Audits

 Supports data integrity through interaction with financial and outcomes systems and auditing verification

 Participates and lead committees, work groups, process improvement efforts, and educational initiatives to improve pharmacy revenue integrity and pharmacy billing cycle

 Conforms to hospital standards of performance and conduct, including those pertaining to patient rights, so that the best possible customer service and patient care may be provided

 

Other information:

 Experience in pharmacy hospital charges, highly preferred
 Experience in hospital billing to commercial and government payers, highly preferred
Location: Vassar Brothers Medical Center

Work Type: Full-Time

Standard Hours: 40.00

FTE: 1.000000

Work Schedule: DAY 8.5

Work Shift: 7 am to 3:30 pm

Org Unit: 1181

Department: Pharmacy

 

Exempt: No

 

Grade: S6

Working conditions:
Essential:
* Little or no potential for occupational risk
* Significant manual skills / motor coord & finger dexterity
* Significant exposure to dirt, odor, noise, human waste, etc.
* Sedentary/light effort. May exert up to 10 lbs. force

 

EOE, including disability/vets.

We will endeavor to make a reasonable accommodation to the known physical or mental limitations of a qualified applicant with a disability unless the accommodation would impose an undue hardship on the operation of our business. If you believe you require such assistance to complete this form or to participate in an interview, please contact Human Resources at 203-739-7330 (for reasonable accommodation requests only). Please provide all information requested to assure that you are considered for current or future opportunities.

City: Poughkeepsie

State: New York

Community / Marketing Title: Pharmacy Charge Specialist

Company Profile:

Health Quest and Western Connecticut Health Network have combined to form a new nonprofit health system. The name for the new health system will be Nuvance Health. The new health system was created to provide communities across New York’s Hudson Valley and western Connecticut with more convenient, accessible and affordable care.

EEO Employer Verbiage:

Location_formattedLocationLong: Poughkeepsie, New York US

Job Number: 37930