Position Summary

This is an onsite, full time, hourly position. This position works within the Pharmacy Revenue Cycle Team to support all assigned pharmacy billing functions. Duties include manual review of identified billing claims through fatal edit reports, reviewing and resolving billing tickets, auditing charge master for appropriateness in built charges, and quarterly reviewing CMS changes in billing requirements. This position will also help develop and maintain SOPs to ensure pharmacy billing functions are optimized to changes in billing requirements. This position reports to the Director of Pharmacy Business Operations, and works closely with Revenue Cycle, and the 340B Team. Phoenix Children’s has a great work culture, and we are looking for an individual with an emphasis on cultural fit, ability to continually learn, and has a “builder” mindset to develop and maintain pharmacy revenue cycle functions.

The Pharmacy Billing Specialist will serve as the point of contact for all medication billing related activities throughout the inpatient and ambulatory sites of care. Scope of work for this role may include the review of medication charges and revenues, research incomplete information related to billing errors/denials, audit existing medication charges, and develop/maintain billing workflows. This individual also ensures new medication billing rules and regulatory changes (CMS and payors) are assessed for compliance, timely processes invoices, and assists in the development of policies and procedures. The Pharmacy Billing Specialist primarily collaborates with Revenue Cycle teams and directly reports to the Director of Pharmacy Business Operations.

Education

• High school diploma or equivalent (Required)
• Associates or Bachelors degree in a related field or equivalent (Preferred)

Experience

• 1.Minimum of one (1) year of experience/exposure to pharmacy billing, medical billing, or equivalent Required (Required)
• 2.At minimum a moderate competency in Excel (Required)
• 3.Knowledge of HCPCS codes, modifiers, ICD-10/CPT codes, and government/commercial payor guidelines (Preferred)
• 4.Knowledge of reimbursement, medical terminology, and HIPAA privacy laws (Preferred)
• 5.Two (2) years of acute health care environment or equivalent experience (Preferred)
• 6.Advanced knowledge and experience in pharmacy coding, billing, and invoicing (Preferred)
• 7.Knowledge of professional fee billing (Preferred)
• 8.Allscripts EHR, and Image Express experience (Preferred)

Certifications

• 1.Current license and registered as a Pharmacy Technician in Arizona (CPhT Certification from PTCB) (Preferred)
• 2.Pharmacy Billing and Reimbursement Certificate from PTCB (Preferred)
• 3.CPhT-Adv Certification from PTCB (Preferred)
• 4.Professional Coding Certification (CPC) (Preferred)

Special Skills

• 1.Proficient with data and document programs (i.e. Microsoft Word, Excel or Access and/or Pivot Tables experience) (Required)
• 2.General knowledge and exposure to a 340B Program and drug purchasing programs (Preferred)
• 3.Auditing experience (Preferred)

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About Phoenix Children's

For more information about the hospital, visit: http://www.phoenixchildrens.org.

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