Primary Intended Outcome(s)
- Creation of an advanced role for a certified pharmacy technician to expand the scope of pharmacyservices
- Enhance the accuracy of pharmacy billing through the provision of a dedicated pharmacy technician
Site Description
UC Health is an integrated delivery network that manages large numbers of acute care and ambulatory patients and has nearly 50 physician offices. UC Health acute care sites include: University of Cincinnati Medical, the flagship academic center; West Chester Hospital, the full-service community hospital; Daniel Drake Center for Post-Acute Care, region’s premier provider of long-term acute care; Lindner Center of HOPE, patient-centered, scientifically-advanced care for individuals suffering with mental illness.
The services offered by the UCMC Pharmacy Department extend across the health system including expertise offered in the inpatient, outpatient, ambulatory, and corporate settings. Certified pharmacy technicians practicing in advanced roles are integral to provide such expansive services and are utilized in unique positions including information technology specialists, medication assistance program coordinators and advocates, and analysts.
Advanced Role Description
The pharmacy technician analyst contributes incomparable value to the organization and limits data management by pharmacy leadership. The role necessitates a strong pharmacy background due to its unique position in both a business and healthcare continuum. The analyst works in conjunction with auditors, physicians, and other healthcare providers in order to complete all necessary tasks associated with the management of medication charges and billing in a comprehensive manner.
The analyst evaluates regular reports from pharmacy IT associates, identifying compliance issues with local coverage determination (LCD), advanced beneficiary notice (ABN), and secondary coverage, among others. Claims with missing information are identified and resolved to provide efficient and timely submission for reimbursement. Problems are resolved and suggested solutions are provided for billing compliance, accuracy, critical decision-making, and cost-saving initiatives.
How to Start
Ensure adequate resources and technology bases are available such as access to the electronic medical record and ability to generate unique reports. The analyst will need access to the electronic medical record to facilitate error correction or omission of information within claims to allow for successful submission. It is key to have the ability to identify specific errors or error-prone areas in order to address the foremost issues. Error-prone areas include missing/incorrect NDC numbers or certain ICD codes, among others. This efficient format allows for optimal workflow.
Regulatory and/or Legal Requirements
The role of the pharmacy analyst technician, under the supervision of UC Health pharmacists, is in compliance with the rules and statutes of the State of Ohio.
Revenue & Expense Parameters (abbreviated financials as applicable)
Direct costs include salary and benefits for the pharmacy technician. Additionally, the technician’s workstation is outfitted with a computer, phone, printer, electronic medical record (EMR) access, office supplies, etc. The approximate cost avoidance is documented and tracked in an internal database, and average $1.4 million per year. The quantity and quality of these interventions are tracked.
Training and/or education requirements
Required:
- Bachelor’s degree or technician education in Pharmacy or Information Systems or an equivalent combination of education and experience
- Working knowledge of Federal and State Medicaid laws and regulations.
- Developed knowledge of Microsoft Word and Excel.
- Developed strong analytical and communication/interviewing skills, including verbal, non-verbal and listening skills.
- Developed fundamental math skill and abilities.
- Self-motivation and organizational skills.
- Developed knowledge of medical terminology.
- General knowledge of hospital insurance plans, reimbursement and Medicare regulations.
- Working knowledge of the hospital billing system and outpatient pharmacy computer.
- Must have developed knowledge of patient accounting systems and processes, computer systems and applications
Preferred:
- Prefer minimum 2 years experience in connection with applications for financial assistance in a healthcare setting
Outcome Measures
- Number of claims with errors
- Corrected claims submitted
- Cost avoidance
- Ongoing professional development e.g., education, and mastering data structure/technology within a health-system
Lessons Learned
- Importance of pharmacy technician involvement to apply knowledge of pharmacy information and workflow to a business setting
- Ongoing professional development e.g., education, professional skills, and mastering data structure/technology within a health-system