Manager, Reimbursement & Collections - Specialty Pharmacy

Trinity Health•Fort Wayne, IN

About The Position

POSITION PURPOSE- located in Fort Wayne, Indiana The Manager, Reimbursement and Collections - Specialty Pharmacy is responsible for implementing both strategic and tactical reimbursement activities within the areas of benefit verification, billing activities, payment applications and collections. This position will provide leadership, strategic direction and supervision of reimbursement functions and activities, ensuring Reimbursement objectives are met. This role manages the implementation and evaluation of corporate reimbursement policies and procedures. This role involves interaction and collaboration with public and private payors, physicians, case managers, consultants, as well as various groups within the pharmacy, including sales, marketing, regulatory and clinical. ESSENTIAL FUNCTIONS Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions. Manages the activities of the corporate Reimbursement Department, including reimbursement operations, billing and coding training, and Revenue Cycle Improvement activities. Builds and motivates highly effective teams with an expertise in Benefits Investigation, Billing, Accounts Receivable, and Payment Processing from public and private insurance companies and clearly communicate expectations and current progress towards those expectations. Reviews and develops finance policies for the appropriate recording of contractual adjustments and settlement items. Oversees payment processing and adjustments from public and private insurance companies and customers in addition to overseeing the reimbursement software, credits, and processing of refunds accurately and timely. Approves contractual and bad-debt adjustments submitted for adjustment request. Approves refunds for patient or third-party overpayments within regulatory or contractual time frames. Formulates reimbursement policy strategy and implements these strategies to shape benefits investigations and reimbursement processes. Monitors, evaluates and reviews all cost reporting in support of reimbursement claims. Understands, monitors and keeps abreast of trends in health economics and reimbursement policies that impact specialty pharmacy. Leads a Reimbursement team to coordinate and execute key strategic projects and objectives to address reimbursement related needs (i.e. - technology enhancements, accounts receivable valuations, and compliance changes). Educates / mentors team members on new and proposed health care laws and regulations. Serves as a resource for forecasting and annual budgets, prepare interim, and annual cost reports. Assists the Compliance Department and members of the executive team with Reimbursement compliance issues as needed. Supports and adheres to the Prime Therapeutics' Compliance Program, to include the Code of Ethics and Business Standards. Participates in quality improvement activities. Complies with all regulatory requirements, including HIPAA/HITECH. Other duties as needed and assigned by the manager. Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.

Requirements

Must possess a comprehensive knowledge of Specialty Pharmacy Billing and Collections and/or home infusion billing and collections, as normally obtained through a Bachelor’s Degree, or equivalent combination of education and experience in business/healthcare administration, finance, or accounting or a related field, and 3 years of experience in medical billing/collections including a working knowledge of managed care, commercial insurance, Medicare and Medicaid reimbursement.
General knowledge of pharmacy and healthcare laws and regulations.
Engages in appropriate continuing professional development.
Knowledge of Microsoft office products, including Word, Excel, PowerPoint and other graphics or presentation software.
Ability to interact effectively with all levels of the organization system-wide.
Written and verbal communication skills to discuss and provide advice/counsel regarding technical or sensitive matters and to communicate effectively with pharmacists, physicians, nurses, vendors, etc.
Diplomacy, tact and listening skills are required in addressing and resolving standard issues.
Must possess service-oriented attitude.
Must possess ability to juggle and prioritize numerous requests simultaneously and manage own work schedule.
Must be comfortable operating in a collaborative, shared leadership environment.
Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.
Must be able to set and organize own work priorities, and adapt to them as they change frequently.
Must be able to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles.
Must possess the ability to comply with Trinity Health policies and procedures.
Frequent immobility and/or sitting required for extended periods of time.
Some bending and stooping required.
Requires manual dexterity to operate keyboard, calculator, photocopy machine, and other office equipment.
Requires eyesight correctable to 20/20 to read reports and computer terminals.
Requires hearing within normal range for telephone use.
Occasional high stress work.

Nice To Haves

Previous leadership experience preferred.
Knowledge of home infusion or mail order pharmacy operations is preferred.

Responsibilities

Manages the activities of the corporate Reimbursement Department, including reimbursement operations, billing and coding training, and Revenue Cycle Improvement activities.
Builds and motivates highly effective teams with an expertise in Benefits Investigation, Billing, Accounts Receivable, and Payment Processing from public and private insurance companies and clearly communicate expectations and current progress towards those expectations.
Reviews and develops finance policies for the appropriate recording of contractual adjustments and settlement items.
Oversees payment processing and adjustments from public and private insurance companies and customers in addition to overseeing the reimbursement software, credits, and processing of refunds accurately and timely.
Approves contractual and bad-debt adjustments submitted for adjustment request.
Approves refunds for patient or third-party overpayments within regulatory or contractual time frames.
Formulates reimbursement policy strategy and implements these strategies to shape benefits investigations and reimbursement processes.
Monitors, evaluates and reviews all cost reporting in support of reimbursement claims.
Understands, monitors and keeps abreast of trends in health economics and reimbursement policies that impact specialty pharmacy.
Leads a Reimbursement team to coordinate and execute key strategic projects and objectives to address reimbursement related needs (i.e. - technology enhancements, accounts receivable valuations, and compliance changes).
Educates / mentors team members on new and proposed health care laws and regulations.
Serves as a resource for forecasting and annual budgets, prepare interim, and annual cost reports.
Assists the Compliance Department and members of the executive team with Reimbursement compliance issues as needed.
Supports and adheres to the Prime Therapeutics' Compliance Program, to include the Code of Ethics and Business Standards.
Participates in quality improvement activities.
Complies with all regulatory requirements, including HIPAA/HITECH.
Other duties as needed and assigned by the manager.