This position performs compliance duties related to pharmacy billing activities, including analysis, monitoring, reporting and billing adjustments to ensure accurate, timely and appropriate charge capture and billing for JW Modifier medications. Coordinates and assists in identifying and correcting potential billing mistakes and in identifying and developing reimbursement opportunities and improvements. This position is an integral component of the revenue cycle process.
Assists Pharmacy Directors in managing accurate and timely charge capture throughout the Pharmacy revenue cycle. Performs daily review and follow through on Patient Charges and exception reports for JW Modifier medications. Identifies problem areas and recommend solutions to Banner Pharmacy Services leadership team. Effectively resolves billing issues and communicates with the Revenue Integrity staff on JW Modifier charging issues.
Works with the Pharmacy Charge Practice team to ensure timely review of all regulatory and third party payer billing requirements to assess their impact on the billing of JW Modifier medications. Reviews CMS program changes and Cerner planned updates that could impact billing practices of JW Modifier medications. Works with Cerner clinical team to add, delete or modify the Cerner drug formulary based on regulatory changes or Banner billing practices that could impact billing of JW Modifier medications.
Maintains an understanding of the CMS JW Modifier program. Corresponds with BPS leadership team to notify them of all changes that could affect billing of JW Modifier medications.
Communicates and provides information as appropriate and performs audits of Pharmacy charges as deemed necessary by Banner Pharmacy Services, Revenue Integrity or Corporate Compliance. Fields questions from compliance, clinics, pharmacists, physicians, Financial or Patient Services, or others concerning charging or billing issues are answered courteously, accurately, completely and in a timely fashion. Issues, problems and any resolution or action taken, if applicable, are reported to the supervisor.
Associates, or minimum of 2 years comparable experience required.
Experience with automated financial systems, CMS, CDM, J Codes and HCPCS. Demonstrates good oral and written communication skills and strong organizational skills. Strong spreadsheet and database skills required.
Experience working in a hospital with pharmacy billing experience strongly encouraged.
Additional related education and/or experience preferred.
You want to change the health care industry – one life at a time. You belong here. You’re excited to be part of the dramatic changes happening in the health care field. In fact, you thrive on change. But you also understand that excellent, compassionate patient care is the true measure of the success of these changes. You belong at Banner Health. Our award-winning, comprehensive health system includes 23 hospitals in seven western states, primary care health centers, research centers, labs, a network of physician practices and much more. Throughout our system, skilled, compassionate professionals use the latest technology to change the way care is provided. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages: •Our vision for changing the future of health care gives you the opportunity to leverage your abilities to achieve something historic. •Our expansive system offers you an unmatched variety of clinical settings – from large urban trauma center to small rural hospital, ambulatory to home health. Our system also includes hospitals specializing in cancer, heart health and pediatrics. •Our many loc...ations also translate into a broad selection of exciting and rewarding lifestyle options – from the big city to the wide-open spaces. •Our commitment to healthcare innovation means you always have the latest technologies at your fingertips to help you provide the finest care possible. •The size, success and growth of our system provide you with the stability and options to pursue your desired career path. •Our competitive compensation and comprehensive benefits offer you options to complement your unique needs.