Coordinator Pharmacy Reimbursement & Bus Ops at Yale New Haven Health

West Haven, Connecticut, United States -

Full Time

Start Date

Immediate

Expiry Date

13 Jun, 26

Salary

0.0

Posted On

15 Mar, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Charge Capture, Reimbursement, Compliance, Auditing, 340B Program, Revenue Integrity, Project Management, Formulary Evaluation, Drug Information, Process Improvement, Change Management, Data Analysis, Presentation Skills, Microsoft Excel, Analytical Skills, Communication

Industry

Hospitals and Health Care

Description

Overview To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day. Under the direction of the Director, Pharmaceutical Procurement and Business Practices the Coordinator of Pharmacy Reimbursement and Business Operations is responsibile for leading and deveoping strategies to maximize efficiency, ensure compliance, charge capture and reimbursement pharmaceuticals. Coordination of activities should be reviewed from the perspective of the health system. EEO/AA/Disability/Veteran Responsibilities 1. System Pharmacy Billing Compliance and Auditing 1.1 Coordinates internal/external audits and reviews results; creates action plans to address variances and to prevent future issue. Identifies regulatory compliance issues, implements solutions and monitors ongoing readiness 2. System Pharmacy 340B Purchasing Program 2.1 Coordinates review of clinic identification and associated Medicare Cost Reporting 3. System Pharmacy Revenue Integrity 3.1 Coordinates charge capture audit review with the physician order entry system 4. Corrdinate implemenation of drug use or medication safety guidelines/protocols/ policies ensuring appropriate assimaliation into billing workflow. Lead and/or assist in charge capture, billing and revenue generation initiatives and serve as primary resource for the system for policy, procedure and issue resolution 5. Lead committee meetings with Corporate Third Party Contracting, Corporate Contracting and Senior Business Operations as appropriate to ensure cohesive initiative implementation and ensure compliance. 6. Support ongoing staff development across system on 340B program, CMS billing and reimbursement . Develop and deliver effective education plans to ensure staff comprehension. 7. Identify and implement opportunities for cost reduction, containment, or revenue enchancement. Assit in review reimbursement analysis for profilt and loss assessments for acquisitions as well as formulary choice 8. Participates in organizational and/or health system committees related to pharmacy services, billing, reimbursement and other hospital initatives as appropriate. 9. Lead and/or assist in charge capture, billing and revenue generation initiatives and serve as primary resource for the system for policy, procedure and issue resolution Qualifications EDUCATION Graduation from an accredited College of Pharmacy with a B.S., M.S., or Pharm. D. degree. Completion of a residency in hospital pharmacy from a program accredited by the American Society of Hospital Pharmacists is highly desired but not required. A minimum of three (3) to five (5) years of hospital pharmacy and related experience in inventory management. EXPERIENCE Minimum of three years of experience in a clinical practice setting with demonstrated skills in formulary evaluation, drug information, and project management. Experience in leading or participating in committees and application of quality improvement techniques is required .The applicant must be a graduate of an accredited College of Pharmacy. Completion of a PGY1 pharmacy practice residency is recommended LICENSURE Connecticut state pharmacy liscence required SPECIAL SKILLS Experience in drug utilization review and data analysis is highly desirable. Excellent written and verbal presentation skills are required. Must posses process improvement and change management skills. Strong working knowledge of electronic spreadsheet applications (e.g. Microsoft Excel), electronic data manipulation, strong math-analytical skills, excellent communication skills, and ability to train other employees. PHYSICAL DEMAND Employee may be expected to work on-call shifts. Coverage extends to day, evening and overnight shifts. Employee is considered essential personnel and is expected to work during inclement weather (i.e. Blizzards, hurricanes) if scheduled. During the course or daily tasks, the employee is required to walk, sit, stand and crouch. The employee must regularly lift/move up to 10 pounds, frequently lift/move up to 25 pounds and occasionally lift/move up to 50 pounds. The employee is occasionally exposed to moving mechanical parts, fumes airborne particles, and toxic or caustic chemicals. The work environment noise level is moderate YNHHS Requisition ID 174460

Responsibilities

This role is responsible for leading and developing strategies to maximize efficiency, ensure compliance, charge capture, and reimbursement for pharmaceuticals within the health system. Key duties include coordinating billing compliance, auditing, managing the 340B purchasing program, and leading revenue integrity initiatives.