Position: Director of Pharmacy Revenue Cycle

Medical Facility: Level 1 Trauma Academic Medical Center | 500+ beds

Reports to: Senior Director of Finance

Department: Revenue Cycle

Schedule: Full Time, Exempt

Salary: $ 130,000 - $150,000

REQUIREMENTS:

Pharmacy Revenue Cycle Experiences
Minimum of 7 years of relevant work experience in financial operations is required.
A minimum of 5 years of management experience is required.
Bachelors’ Degree in Finance or Business or Financial Management or related field

Job Description:

Under the general direction of, and guidance from, the Senior Director of Revenue Cycle Operations, the Pharmacy Revenue Cycle Director provides oversight of the revenue cycle functions for the Outpatient, Retail, and Contract pharmacy revenue cycle management. The Director is responsible for the creation and implementation of accurate charging and billing best practices, accounts receivable management, and work queue management, and ensures follow-up on all outstanding claims and accurate cash reconciliation is conducted. The Director is responsible for establishing the organizational priorities and operational strategies to drive optimal performance of the Pharmacy Revenue Cycle program.

The Director acts as a liaison between pharmacy leadership, Finance leadership, third-party billing vendor leadership, and other departments as relevant within the organization. The Director is responsible for providing operational direction to pharmacy managers and billing analysts that support pharmacy revenue cycle processes and procedures and ensures key quality performance indicators are developed, tracked, and maintained to set parameters. The Director also provides root cause analysis and clear operational processes for plans of correction when performance indicators are not meeting set parameters.

This position is responsible for leading the Epic pharmacy revenue cycle processes in the inpatient pharmacies with a focus on analyzing, coordinating, and building a scalable charging/reimbursement function for pharmacy services. This includes determining eligibility, verification of benefits, medication prior authorizations, claims adjudication, collection activities, and cash application with appropriate internal controls and operating metrics. This also includes strict adherence to applicable compliance and regulatory policies, coordination of benefits across primary, and managing the people, processes and technology from the revenue cycle end-to-end.

The Director will be responsible for creating programs that define and execute quality, efficient, and effective standards for the pharmacy revenue cycle and complementary functions.

Revenue Cycle Management

Directs the activities of the Pharmacy Sr. Manager and Pharmacy Analysts team to ensure operational excellence and delivery of quality patient-focused services in accordance with applicable policies, procedures, and professional standards.
Oversees the Third-Party Billing Vendor(s) to ensure billing software and standards are in alignment with established performance metrics to maximize our revenue opportunity and facilitate timely reimbursement.
Provides vision and leadership expertise in guiding the complete process of re-engineering Pharmacy Revenue cycle operational processes and procedures as deemed appropriate.
Develops standard performance metrics for the pharmacy’s revenue cycle management. The financial measurements/indicators shall illustrate the positive and negative trends of the pharmacy’s revenue collection.
Manages PBM contracts and prepares them for review, renewal, assists with negotiations (e.g. recommending terms and conditions etc.) and ensures all are current for all stores.
Leads an on-going review process of the negative trends and investigates the root cause of these trends. Recommends actions for corrections. Communicate trends and corrective action plans to pharmacy leadership and other stakeholders and impact to the bottom line.
Leads the enhancement of existing revenue cycle systems or business processes, with the focus being to gain efficiencies and improve revenue collections for the hospital. This includes working closely with the pharmacy managers and senior leaders to enhance and /or eliminate unnecessary manual processes.

Daily Department Management

Responsible for effective fiscal management of departmental operations to ensure proper utilization of departmental financial resources; assists with the departmental budget and manages to budget.
Works with other leaders to provide continuous training to the all users, department directors and managers to ensure systems utilization is at maximum capability.
Enhances operational protocols and use statistics/metrics to determine overall performance and effectiveness, team performance and error rates, deficits in systems, etc. Communicates those metrics to the Senior Director of Revenue Cycle Operations, VP of Revenue Cycle, Pharmacy Leadership and other stakeholders.
Reviews, updates and implements policies and procedures as it relates to the functions of the Pharmacy revenue cycle processes
Actively involved in activities to ensure patient and employee satisfaction.
Engineers and maintains a Pharmacy Revenue model that supports the Hospital and clinical operations

Human Resources Management

Institutes applicable training; initiates updated job requirements/descriptions for all staff; mandatory training, certification, and continual quality audits, e.g. Performance standards
Conducts routine department and staff meetings
Oversees activities to ensure goals and objectives of the organization are met by specified target dates
Creates and fosters a work environment that encourages productivity and work loyalty and employee satisfaction.
Conducts performance appraisals for direct report staff and ensures all performance appraisals in department are completed timely.
Maintains appropriate staffing levels by planning and working closely with recruiters in Human Resources and the Revenue Cycle Human Resources Business Partner

Technical

Extensive working knowledge of healthcare applications including, but not limited to Epic, payer websites, QS1, NetRx, Sales Force, etc.
Highly skilled experience and knowledge of Windows-based software required, including but not limited to Microsoft Outlook, Word, PowerPoint, and Excel.
Comprehensive understanding of retail pharmacy claim adjudication processes and procedures, billing and regulations, guidelines pertaining to third-party payers and self-payers, and health insurance refunds and credit standards.
Proficient skills to collect, organize and analyze data, produce actionable reports, and recommend improvements and solutions.

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Director of Pharmacy Revenue Cycle