Description:
Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect. Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work. Job Summary: Supports accurate and compliant medication charging, billing, and reimbursement across outpatient hospital departments such as observation units, emergency departments, outpatient surgery centers, and infusion clinics. Ensures medication-related charges are complete, accurate, compliant, and aligned with Centers for Medicare and Medicaid Services (CMS), health resources & services administration (HRSA), and payer regulations. Serves as the bridge between pharmacy operations, revenue cycle, compliance, and finance, using deep understanding of pharmacy workflows, coding, charge capture, and payer requirements to prevent revenue leakage and mitigate compliance risks. Job Requirements: Education and Work Experience: High School Education/GED or equivalent: Preferred Associate?s/Technical Degree or equivalent combination of education/related experience: Preferred Three years' of experience in hospital or health system pharmacy, revenue integrity, billing, or compliance: Required Experience working in Epic Resolute, Cerner Revenue Cycle, or similar EMR/billing systems: Preferred Licenses/Certifications: State Pharmacy Technician license: Required (CA, OR, &/or HI): Required Pharmaceutical Technician Board certification: Preferred Advanced certification (e.g., CHRI, CRCR, or 340B ACE): Preferred State Pharmacy Technician license: Required Essential Functions: Reviews and reconciles medication charges in outpatient hospital encounters (e.g., observation, infusion, surgery, emergency department (ED)). Validates NDC-to-HCPCS mapping, billable units, and appropriate modifiers (e.g., JZ/JW) per CMS and payer guidelines. Ensures compliance with 340B, GPO, and WAC pricing policies; collaborate with 340B Program Integrity teams to maintain audit readiness. Participates in internal and external audits (CMS, HRSA, internal compliance, or payer audits). Identifies and corrects charge capture errors prior to billing to ensure clean claims submission. Monitors UB-04 claim accuracy for outpatient medication billing and ensure HCPCS and revenue codes align with clinical documentation. Collaborates with revenue integrity, HIM, and pharmacy to maintain compliant and optimized CDM (Charge Description Master)/ Medication Record Master File (ERX) entries for medications. Stays current on CMS outpatient prospective payment system (OPPS) updates, HRSA guidance, NDC-to-HCPCS quarterly crosswalks, and payer-specific requirements. Supports resolution of claim denials related to outpatient drug charges, waste modifiers, medical n...
Requirements:
At least two years recent experience in field, current BLS certification, and a current nursing license per the state of assignment. For additional and specialty-specific requirement, please contact us