Pharmacy Revenue Management - Reimbursement Specialist

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together. About Duke University Hospital Pursue your passion for caring with Duke University Hospital in Durham, North Carolina, which is consistently ranked among the best in the United States. The largest of the four Duke Healthhospitals with 1062 patient beds, it features comprehensive diagnostic and therapeutic facilities, including a regional emergency/trauma center, an endo-surgery center, and more. Remote Must Reside in North Carolina General Description of the Job Class 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. Duties and Responsibilities of this Level 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. Required Qualifications at this Level Education High school diploma or equivalent is required, preferably supplemented by post-secondary courses in Accounting, Finance, Economics, Business Administration or a related field. Experience Four years of related experience in healthcare is required. A Bachelor's degree in a related field can substitute for the experience requirement. Degrees, Licensure, and/or Certification N/A Knowledge, Skills, and Abilities Data analysis and reporting Billing/Collections Insurance Claims Microsoft Office (Excel, Access, Word, Powerpoint) Good communication skills (verbal and written) are essential. Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex (including pregnancy and pregnancy related conditions), sexual orientation or military status. Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.

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Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.