Director, Pharmacy Revenue Integrity

Atlantic Health System • Morristown, NJ

94d

About The Position

Under the general supervision of the Vice President for Pharmacy services, this position is responsible for all pharmacy cost and revenue related activities such as report preparation, department audits, reconciliation procedures, QA monitoring, denials management, revenue-based statistics, CDM (Charge Description Master) maintenance, and training clinical staff on charge-capture processes and subsequent charge review post procedure.

Requirements

• Pharmacy Bachelor's Degree or Graduation from an accredited School of Pharmacy with PharmD required.
• Current active registration and licensure with the State of New Jersey Board of Pharmacy required or eligible for licensure in the State of New Jersey.
• 5 plus years of previous hospital pharmacy experience preferred.

Nice To Haves

• Strong project management, analytical, and leadership skills.
• Demonstrated ability to assess and address organizational needs.
• Proven record of working effectively with all levels of staff preferably within a large hospital setting.
• Demonstrated success in developing and implementing significant initiatives within complex, matrixed environments.
• Extensive experience working with Epic as an electronic health record (EHR) system.

Responsibilities

• Supports cost and revenue impact decision making related to new drug/biosimilar product addition and removal from formulary.
• Provides assistance to all pharmacy revenue generating departments to ensure uniform application of the Charge Master in all areas, regulatory agency compliance and compliance with System policies and procedures.
• Coordinates departmental Charge Master reviews and recommends price increase changes as needed.
• Provides education and assistance to the pharmacy director and managers regarding function of the Charge Master.
• Ensures appropriate compliance with Charge Master and revenue capture processes for new pharmacy services being considered by the facility.
• Performs department charge process and charge reconciliation audits to ensure compliance with hospital and department policy and procedures; creates and modifies policies and procedures relating to gross revenue and reconciliation processes.
• Oversees all patient charge audits.
• Monitors departmental usage of reports to ensure issues are being identified and addressed with continuous quality improvements in addition to providing education to departments on improving pharmacy revenue accuracy.
• Builds collaborative relationships with internal and external stakeholders to execute revenue cycle management goals and objectives.
• Coordinates charge capture audits with the appropriate teams to identify charge capture loss, identifies the gaps and process improvement opportunities, identifies and implements best practice resolutions, communicates changes, metrics and ongoing improvement initiatives.
• Works with all personnel involved in the pharmacy revenue cycle to optimize technology in the charge capture process.
• Supports timely resolution of issues, provides incident management and problem resolution.
• Assists external departments in denial management.
• Works with strategic sourcing and GPO for contract performance and financial impacts.
• Creates P&L for all medications and advises P&T on inpatient and outpatient formulary.

What This Job Offers

• Industry: Ambulatory Health Care Services
• Education Level: Bachelor's degree