Cedars-Sinai Pharmacy Billing and Reimbursement Coordinator in Los Angeles, California

Pharmacy Billing and Reimbursement Coordinator Requisition # M11893A

Job Summary:

The Pharmacy Billing and Reimbursement Coordinator provides support as an educational resource and promotes appropriate coding, billing, documentation and reimbursement practices in compliance with regulatory and payor requirements for medications administered in physician offices. The Pharmacy Billing and Reimbursement Coordinator reviews medical and billing records to ensure accuracy; identifies, investigates and resolves issues and discrepancies; educates and seeks opportunities to promote appropriate coding, billing, documentation and reimbursement; identifies trends and recommends corrective action if needed; and prepares reports, documents, and training material for staff.

Essential Job Duties:

• Serves as a resource and liaison between Pharmacy Services, Physician Billing Services and Clinical Departments in ensuring appropriate coding, billing, documentation and reimbursement of charges related to medication administration;
• Conducts reviews of medical records for claims, charges, documentation, and adjudication of payments for medications administered in physician offices within established timeframes;
• Supports the department by acting as a resource for appropriate coding and documentation of charges related to medication administration;
• Identifies and addresses insurance, coding, billing, documentation, and payment issues related to medication administration charges from a compliance and reimbursement perspective;
• Investigates and responds to questions regarding documentation and coding issues;
• Identifies and communicates changes that impact coding, medication order templates and fee ticket design with the appropriate parties (i.e. billing services, pharmacy services, etc.);
• Identifies coding and documentation discrepancies in reviewing medical/billing records and recommends actions to improve third-party reimbursement and minimize audit liability;
• Communicates chart review findings and discrepancies to Manager, Pharmacy Business Operations and appropriate parties as directed;
• Maintains pharmacy charge files and the Master Injectable Fee Ticket Database;
• Makes recommendations for improved operational processes so that billing information is received from client groups in a timely and accurate manner;
• Utilizes computerized records to receive various medical reports;
• Maintain current HCPCS, CPT and ICD-10 knowledge of charges related to the administration of medication to ensure coding remains current;
• Assists with identification and development of appropriate coding for new services and procedures provided by clinicians;
• Coordinates the review of medical records and financial accounts with coding department and providers to maximize reimbursement;
• Keeps apprised and provides up-to-date information regarding compliance and regulatory/payor requirements pertaining to the coding and reimbursement of medication administration;
• Prepares reports, documents, and educational training materials for staff;
• Attends meetings and participates in group problem solving;
• Performs other duties and responsibilities as assigned.

Qualification Requirements/Preferences:

Education Certifications/Licensure Experience Physical Abilities Minimum Job Requirements/Competencies:

High School graduate or general education degree (GED); 5+ years of experience in a professional billing setting reviewing and interpreting patient medical records using HCPCS, CPT and ICD-10 CM coding systems; knowledge of physician billing practices and third party reimbursement guidelines and adjudication systems; working knowledge of medical terminology; computer literate to perform basic data entry (knowledge of Excel spreadsheets preferred); ability to work with online computerized systems and PC-based software applications (Microsoft Suite, such as Word, Excel and Outlook); demonstrated ability to work with all internal and external customers in a professional manner; ability to work in a changing environment and handle multiple conflicting priorities; excellent interpersonal and customer relations skills

Certificates, Licenses, and Registrations:

Certified Professional Coder (CPC) or Certified Coding Specialist Physician (CCS-P) or Registered Health Information Technologist (RHIT) or Registered Health Information Administrator (RHIA) or Certified Coding Associate (CCA) by American Health Information Management Certification (AHIMA) preferred; Certified Pharmacy Technician License preferred

Language Skills:

Excellent verbal communication skills to include effective telephone dialogue skills. Ability to read, interpret documents, routine reports/correspondence, patient charts, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers and/or employees of the organization.

Mathematical Skills:

Ability to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rates, ratios, and percentages.

Reasoning Ability:

Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Physical Demands:

Ability to sit for long periods of time, computer use and answer telephones.

Working Conditions:

Organizational Expectations: Demonstrates behavior that supports the Cedars-Sinai Health System mission. Attends required orientation and training seminars. Meets production standards within established time requirements. Work product and performance meets quality standards. Demonstrates respect and positive interpersonal skills with patients, clients, the public, managers, and co-workers—a team player. Maintains confidentiality of patient care and business matters. Observes time, attendance, and dress code standards. Protects the safety of others and of the physical plant and equipment, following institution policies, fire, safety and infection control regulations.

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of employees classified in this job.

  • Working Title: Pharmacy Billing and Reimbursement Coordinator
  • Business Entity: MDN - Medical Delivery Network
  • Cost Center # - Cost Center Name: 0106000 - Medical Services
  • City: Los Angeles
  • Job Category: Finance/Patient Financial Services
  • Job Specialty: Physicians Billing
  • Position Type: Regular-F/T
  • Shift Length: 8hr
  • Hours: 8:00am - 5:00pm
  • Days: Monday - Friday
  • Shift Type: Day
  • Weekends: None

Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law. If you need a reasonable accommodation for any part of the employment process, please contact us by email at Applicant_Accommodation@cshs.org and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this email address.

Cedars-Sinai will consider for employment qualified applicants with criminal histories, in accordance with the Los Angeles Fair Chance Initiative for Hiring.

At Cedars-Sinai, we are dedicated to the safety, health and wellbeing of our patients and employees. This includes protecting our patients from communicable diseases, such as influenza (flu). For this reason, we require that all new employees receive a flu vaccine based on the seasonal availability of flu vaccine (typically during September through March each year) as a condition of employment, and annually thereafter as a condition of continued employment.