Certified Pharmacy Reimbursement Specialist - Complex Care
About The Position
Discover Vanderbilt University Medical Center : Located in Nashville, Tennessee, and operating at a global crossroads of teaching, discovery, and patient care, VUMC is a community of individuals who come to work each day with the simple aim of changing the world. It is a place where your expertise will be valued, your knowledge expanded, and your abilities challenged. Vanderbilt Health is committed to an environment where everyone has the chance to thrive and where your uniqueness is sought and celebrated. It is a place where employees know they are part of something that is bigger than themselves, take exceptional pride in their work and never settle for what was good enough yesterday. Vanderbilt’s mission is to advance health and wellness through preeminent programs in patient care, education, and research. Organization: Pharmacy Complex Care Tech Coo Job Summary: Evaluates reimbursement of medications provided to inpatients, clinic patients and patients receiving prescriptions through the outpatient pharmacy network. Works with multidisciplinary groups to develop proper procedures and programs to maximize reimbursement. Facilitates process and system improvements to reduce the likelihood of occurrence of loss of reimbursement relating to pharmaceuticals. Assists with maintaining drug and payer data files in the dispensing system. Works with dispensing staff and/or Payor Help Desk Staff to troubleshoot issues with medication claims and, when needed, editing/resubmitting claims in the OP dispensing system. . Position Highlights Hours are Monday - Friday 8:00am - 4:30pm. No weekends and no holidays. Hybrid schedule available after onboarding and training have been successfully completed. Responsibilities include but are not limited to data entry, prior authorizations, setting up mail outs, and prescription verifications. Must be a Certified Pharmacy Technician through either PTCB or NHA in order to be considered. Key Responsibilities Clarifies and trends pharmaceutical denials and underpayments of the highest cost drugs and other drugs. Utilizes data from finance and pharmacy systems to determine reimbursement rates for pharmaceuticals for various patient care settings. Evaluates actual reimbursement compared to defined contractual reimbursement rates for specific drugs/procedures. Provides trending on reimbursement and information on areas for focus to maximize reimbursement. Maintains data in appropriate database to facilitate evaluation and presentation of data. Evaluates data enabling the identification of trends by multiple variables. Works with patient accounting, finance, contracts and pharmacy to develop strategy for improved reimbursement. Utilizing data collected, defines areas for focus to maximize reimbursement and presents plan to above departments. Maintains list of potential opportunities for reimbursement and contracting based on proactive review of data. Works collaboratively to develop programs and procedures to maximize reimbursement of pharmaceuticals. Facilitates process and system improvements to reduce the likelihood of occurrence of loss of reimbursement relating to pharmaceuticals. Works with pharmacy staff and finance to evaluate reimbursement of new drugs and proposes necessary procedures to maximize reimbursement. Documents enhanced reimbursement from developed programs and trend success of programs. Utilizes databases maintained to provide documentation to support the effectiveness of the reimbursement program. Assists with regulatory compliance related to safe medication use with program, operational, regulatory bodies (JCAHO, ASHP, state and federal regulations, Leapfrog, etc.), and institutional policies and procedures. Provides written monthly update on activities and financial impact of program to enhance reimbursement. Assists billing manager and documents regulatory compliance related to billing of pharmaceuticals and works to correct any variances. Works with Patient Assistance Programs (PAP) to include identifying new opportunities, document receipt of funds and provide proper adjustment of patient accounting accounts. Collaborates with pharmacy, finance, contracts and patient accounting to identify ongoing opportunities to expand the PAP to reduce drug cost. Documents savings from the PAP and provides a monthly report trending the savings from the program. Provides recommendations to pharmacy administration for input into hospital contracting for enhanced reimbursement. Maintains proper resources and contacts to understand the contractual reimbursement of pharmaceuticals. Maintains documentation on any issues with contractual reimbursement including the financial impact for review by pharmacy, finance and contracting. Contributes to the continuing education of pharmacy on the reimbursement of pharmaceuticals and the contractual trends for reimbursement. As permitted by law, may receive or transfer oral prescriptions for dispensed medications under the supervision of a pharmacist. Our professional administrative functions include critical supporting roles in information technology and informatics, finance, administration, legal and community affairs, human resources, communications and marketing, development, facilities, and many more. At our growing health system, we support each other and encourage excellence among all who are part of our workforce. High-achieving employees stay at Vanderbilt Health for professional growth, appreciation of benefits, and a sense of community and purpose.
Requirements
- Must be a Certified Pharmacy Technician through either PTCB or NHA in order to be considered.
- Certifications: Certified Pharmacy Technician - National Healthcareer Association - National HealthCareer AssociationNational HealthCareer Association, Certified Pharmacy Technician - Pharmacy Technician Certification Board - Pharmacy Technician Certification BoardPharmacy Technician Certification Board, LIC-Pharmacy Technician - TennesseeTennessee
- Work Experience: Relevant Work Experience
- Experience Level: 2 years
- Education: Graduate of an approved discipline specific program
Responsibilities
- Clarifies and trends pharmaceutical denials and underpayments of the highest cost drugs and other drugs.
- Utilizes data from finance and pharmacy systems to determine reimbursement rates for pharmaceuticals for various patient care settings.
- Evaluates actual reimbursement compared to defined contractual reimbursement rates for specific drugs/procedures.
- Provides trending on reimbursement and information on areas for focus to maximize reimbursement.
- Maintains data in appropriate database to facilitate evaluation and presentation of data.
- Evaluates data enabling the identification of trends by multiple variables.
- Works with patient accounting, finance, contracts and pharmacy to develop strategy for improved reimbursement.
- Utilizing data collected, defines areas for focus to maximize reimbursement and presents plan to above departments.
- Maintains list of potential opportunities for reimbursement and contracting based on proactive review of data.
- Works collaboratively to develop programs and procedures to maximize reimbursement of pharmaceuticals.
- Facilitates process and system improvements to reduce the likelihood of occurrence of loss of reimbursement relating to pharmaceuticals.
- Works with pharmacy staff and finance to evaluate reimbursement of new drugs and proposes necessary procedures to maximize reimbursement.
- Documents enhanced reimbursement from developed programs and trend success of programs.
- Utilizes databases maintained to provide documentation to support the effectiveness of the reimbursement program.
- Assists with regulatory compliance related to safe medication use with program, operational, regulatory bodies (JCAHO, ASHP, state and federal regulations, Leapfrog, etc.), and institutional policies and procedures.
- Provides written monthly update on activities and financial impact of program to enhance reimbursement.
- Assists billing manager and documents regulatory compliance related to billing of pharmaceuticals and works to correct any variances.
- Works with Patient Assistance Programs (PAP) to include identifying new opportunities, document receipt of funds and provide proper adjustment of patient accounting accounts.
- Collaborates with pharmacy, finance, contracts and patient accounting to identify ongoing opportunities to expand the PAP to reduce drug cost.
- Documents savings from the PAP and provides a monthly report trending the savings from the program.
- Provides recommendations to pharmacy administration for input into hospital contracting for enhanced reimbursement.
- Maintains proper resources and contacts to understand the contractual reimbursement of pharmaceuticals.
- Maintains documentation on any issues with contractual reimbursement including the financial impact for review by pharmacy, finance and contracting.
- Contributes to the continuing education of pharmacy on the reimbursement of pharmaceuticals and the contractual trends for reimbursement.
- As permitted by law, may receive or transfer oral prescriptions for dispensed medications under the supervision of a pharmacist.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
