Pharmacy Billing & Compliance Analyst

Job Summary:
The Pharmacy Billing and Compliance Analyst is responsible for working with all inpatient units and outpatient clinics to ensure compliance with medication safety and billing regulations. This position conducts audits of both inpatient and outpatient clinics and works to correct and maintain standards of medication safety. After an audit, the Pharmacy Billing and Compliance Analyst will report their findings to Pharmacy Leadership and the audited unit's leadership team. This Analyst also researches medication safety trends and works pro-actively to correct any non-compliance with UVMMC medication safety, storage, and maintenance policies. The Analyst works to ensure compliance with The Joint Commission (JCAHO) and all applicable laws, regulations, and professional standards relating to medication safety, storage, and maintenance. The Analyst also works with inpatient units and outpatient clinics to educate, investigate, and resolve any medication safety compliance issues or concerns and acts as the primary contact for medication safety concerns in clinics and units supplied with medication by the Inpatient Pharmacy.

The Analyst supports the Dialysis Home Program billing process ensuring that all manual billing for Home Dialysis patients that takes place outside of the automated systems is charged promptly and is correctly entered into the appropriate systems. This position works with the Practice Supervisor and other Dialysis team members to obtain data related to the medications administered to patients taking part in the Home Dialysis Program. 

This position is responsible for researching and manually posting emergency code medication charges for the E.D and other departments that fail to reach the billing system from EPIC while ascertaining if billed charges are supported by documentation in the medical record. 

The Analyst is responsible for the tracking, billing, and documentation of transfers of medications between hospital departments and pharmacies. The Analyst serves as the primary contact for any billing and compliance related questions or concerns.

This position is also responsible for tracking of medications dispensed from Pyxis by reconciling and matching patients with corresponding visits. 

The Pharmacy Billing and Compliance Analyst works with the OR nursing team, Anesthesiology team, and the OR Pharmacy Technician Specialist to investigate and monitor medication usage during all OR procedures. This includes analyzing medications given during a procedure, ensuring the Anesthesia record is correct, and that all medication charges have been properly processed and posted. This position works to ensure departmental medication waste is properly charged to the UVMMC OR department.

The Analyst works with the narcotic room on recordkeeping of narcotics that are sent to the Paramedic sites and ensures that the sites follow DEA requirements and regulations regarding storage of controlled substances given or used by the authorized Paramedic teams. This includes manually charging the paramedic units for medications that have been administered, wasted, or expired.  
The Analyst is responsible for recordkeeping, documentation and billing of all medications sent to paramedic sites, hospitals, nursing homes, veterinary sites and clinics. This position communicates and works with Financial Edge to submit, monitor, and obtain payment for new and delinquent invoices. The Analyst contacts sites to resolve outstanding invoices and assists with payment remittance.

The Analyst works on the COA/COD report to ensure all medications dispensed from the pharmacy are properly charged based on administration in the patient chart. The position is responsible for analyzing high-cost medication usage and discrepancies between dispensations and administrations. This role uses EPIC, DOSEDGE, and Pyxis ES to perform analysis and resolve any discovered billing discrepancies according to billing and compliance standards. The Analyst works closely with the Pharmacy department, EPIC team and clinical providers to ensure accurate and compliant medication charging. 

The Analyst is also involved in reporting medication cost and purchase records to internal parties. This role is responsible for working the CIN (Cardinal Identification Number) Change Tracker and updating Pharmacy systems with new medication information. The Analyst participates in internal policy reviews and partakes in regular meetings related to medication auditing, billing and compliance. 
 

Education:

Associate degree or combination of education and experience required.

College course work with auditing, billing, compliance, Pharmacy or accounting background preferred.

Must be licensed as a Pharmacy Technician in the State of Vermont. 

 
Experience:
Two years of experience as a Pharmacy Technician with working experience in an acute care setting preferred. Knowledge of medication inventory/distribution systems and medication safety/auditing/billing experience preferred. Must have familiarity with 340B Drug Pricing Program.