Pharmacy Billing & Compliance Analyst - The Panther Group
New York, NY 10017
About the Job
Pharmacy Billing & Compliance Analyst
Job Description:
Pharmacy Billing Compliance
Time: 40%
Billing compliance for various types of medications and associated charges
Performance Expectations:
- Review MSKCCs compliance/risk management tool daily: analyze and report any pharmacy related coding changes; and recommend appropriate policy and procedure changes to the management team.
- In collaboration with Patient Accounts, audit pharmacy charge records and make charge/credit adjustments where necessary.
- Represents the Pharmacy Division in internal and external audits related to pharmacy billing; implements policy and procedure changes that result.
- Performs routine audits and quality assurance reviews of pharmaceutical charge activities
- Identify potential areas of compliance vulnerability and risk; Develop and make recommendations for corrective action.;
- Provide general guidance and advice to pharmacy leadership on compliance issues and resolution.
- Audit retail medication reversals and re bills for compliance accuracy.
- Responsible for the maintenance and update of all Pharmacy policies and procedures related to pharmacy billing compliance.
Time: 40%
Performance Expectations:
- Responsible for ensuring timely and accurate billing via the automated interface between our clinical pharmacy and patient accounts/finance systems.
- Review billing exception reports and reasonability bases lines to ensure appropriate billing.
- Provide direct support to Pharmacy, Patient Accounts or other MSK staff for pharmacy billing inquiries and trouble calls.
- Manage a bi-annual update of pharmaceutical AWP prices, ensuring coordination between the Pharmacy clinical system and our patient accounts and finance systems.
- Conduct a quarterly analysis of our pharmaceutical prices by comparing average acquisition costs to average wholesale prices; determine if any price adjustments are appropriate; and implement adjustments at the direction of Pharmacy management.
- Review discrepancies between the date of administration and the date of the pharmacy charge; perform chart reviews to determine the appropriate date of service; make charge corrections where necessary; and recommend order corrections to pharmacy staff.
- Review pharmacy charge related IDB quality reports, perform chart reviews to determine if corrective action is required.
- Manage pharmacy medication pump billing and tracking program.
- Implement a pharmacy division billing compliance education and training program.
- Respond to Patient Account inquiries regarding retail prescriptions; evaluate, identify and address billing discrepancies; escalate as needed to pharmacy leadership.
- Execute a monthly reconciliation of expected and actual retail prescription reimbursements from prescription plan payers to ensure that MSK is receiving all due payments.
- SQL Report Writing skills
Time: 15%
Performance Expectations:
- Assist pharmacy informatics staff in all aspects of routine internal and external compliance audits.
- Issue charges or credits as directed by the manager of Pharmacy Billing to address inappropriate medication charges.
- Participate in system testing projects, especially those related to medication billing compliance.
- Identifies gaps in existing reports, and designs new ones using report writing tools and software, such as SQL.
- Performs any other project at the direction of the manager of Pharmacy Billing.
Time: 5%
Completes projects and/or activities, which meet departmental criteria to maintain and advance professional competency based on divisional guidelines.
Performance Expectations:
- Attends/documents attendance of Pharmacy sponsored meetings, i.e. continuing education programs, grand rounds, and general staff meetings when coverage is available, and workload permits.
- Participates in any relevant/related training sessions at the direction of the Manager of Pharmacy Billing.
Source : The Panther Group