Pharmacy Revenue Management - Reimbursement Specialist
Duke Careers•Durham, NC
•Onsite
About The Position
The Reimbursement Specialist within the Pharmacy Revenue Management Team is responsible for expert review of pharmacy related charge audits and work queues in Epic. They will review and analyze pharmacy charges, collaborating with Duke Health Technology Solutions, Patient Revenue Management Organization, and Finance to ensure compliance with billing regulations while maximizing revenue capture.
Requirements
- High school diploma or equivalent is required, preferably supplemented by post-secondary courses in Accounting, Finance, Economics, Business Administration or a related field.
- Four years of related experience in healthcare is required.
- A Bachelor's degree in a related field can substitute for the experience requirement.
- Data analysis and reporting
- Billing/Collections
- Insurance Claims
- Microsoft Office (Excel, Access, Word, Powerpoint)
- Good communication skills (verbal and written) are essential.
Responsibilities
- Review charges in pharmacy work queues for appropriate billing and waste capture
- Perform compliance audits on pharmacy charges and documentation
- Reconcile dispenses with charges to capture missed revenue opportunity
- Communicate and correct documentation errors with clinical staff. Provide education as needed.
- Analyze and provide feedback for pharmacy specific reports.
- Utilizes clinical and coding knowledge to ensure accurate and compliant charge items and to recognize and resolve billing inconsistencies.
- Coordinates projects and audits to improve processes related to revenue cycle, efficiency of charging and billing, and collection efforts.
- Trend and report on departmental performance indicators and goals. Ensure departmental goals are satisfied.
- Make recommendations to improve financial systems; perform in house audits of operating units; analyze deficiencies and report to manager/director.
- Assist in developing and defining short and long term departmental specific goals and objectives.
- Maintain professional relationship with internal and external agencies and professional organizations concerning operations.
- Perform other related duties incidental to the work described herein.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
Upload and Match Resume
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
