Allied Technician - Pharmacy Tech

Pharmacy Billing Compliance Specialist

We are seeking a dedicated and detail-oriented Pharmacy Billing Compliance Specialist to support accurate and compliant medication charging, billing, and reimbursement across various outpatient hospital departments. This role is essential in ensuring medication-related charges are complete, accurate, compliant, and aligned with regulations from the Centers for Medicare and Medicaid Services (CMS), health resources & services administration (HRSA), and payer guidelines.

Key Responsibilities:

• Review and reconcile medication charges in outpatient hospital encounters, including observation, infusion, surgery, and emergency departments.
• Validate National Drug Code (NDC) to Healthcare Common Procedure Coding System (HCPCS) mapping, billable units, and appropriate modifiers in accordance with CMS and payer requirements.
• Ensure compliance with 340B, Group Purchasing Organization (GPO), and Wholesale Acquisition Cost (WAC) pricing policies, collaborating with 340B Program Integrity teams to maintain audit readiness.
• Participate in internal and external audits, including those conducted by CMS, HRSA, and payer audits.
• Identify and correct charge capture errors prior to billing to ensure the submission of clean claims.
• Monitor UB-04 claim accuracy for outpatient medication billing, ensuring HCPCS and revenue codes align with clinical documentation.
• Collaborate with revenue integrity, Health Information Management (HIM), and pharmacy teams to maintain compliant and optimized Charge Description Master (CDM) and Medication Record Master File (ERX) entries.
• Stay updated on CMS outpatient prospective payment system (OPPS) modifications, HRSA guidance, NDC-to-HCPCS quarterly crosswalks, and specific payer requirements.
• Support the resolution of claim denials related to outpatient drug charges and associated modifiers.

Qualifications:

• High School Education/GED or equivalent; Associate's/Technical Degree or relevant experience preferred.
• Minimum of three years' experience in pharmacy, revenue integrity, billing, or compliance is required.
• Experience with Epic Resolute, Cerner Revenue Cycle, or similar EMR/billing systems is preferred.
• Current State Pharmacy Technician license is required (CA, OR, &/or HI).
• Pharmaceutical Technician Board certification is preferred.
• Advanced certification such as CHRI, CRCR, or 340B ACE is also preferred.

If you are passionate about pharmacy operations and want to contribute to enhancing the revenue cycle through precise medication billing and compliance, we encourage you to apply for this position.

Client Details City Roseville State CA