Medical Director Jobs

About The Position

Requirements

• Meet The Wright Center for Community Health and its affiliated entity The Wright Center for Graduate Medical Education EOS© People Analyzer Tool
• Buy in and experience working in the EOS® model (strongly preferred)
• Mission-oriented; represents the enterprise in a professional manner while demonstrating organizational pride
• Associate’s or Bachelor's degree in Accounting, Finance, Business Administration, Healthcare Administration, or equivalent experience required.
• Minimum two years of experience in healthcare billing, pharmacy finance, revenue cycle, accounting support, reimbursement analysis, or related financial operations.
• Strong understanding of accounting principles, Experience reconciling financial transactions and researching payment discrepancies.
• Strong analytical and critical thinking skills.
• Strong organizational skills with ability to manage multiple priorities and meet deadlines.
• Advanced attention to detail.
• Excellent verbal and written communication skills.
• Strong Microsoft Excel proficiency.
• Experience working with financial reporting systems, pharmacy billing systems and healthcare reimbursement data.

Nice To Haves

• Minimum one to two years of pharmacy experience
• Experience with pharmacy management systems (e.g., PioneerRx, ProviderPay)
• Experience with vaccine program administration.
• Accounts receivable reconciliation experience
• Healthcare reimbursement analysis experience

Responsibilities

• Reconcile billing transactions for retail in-house, specialty, and contract pharmacy services.
• Reconcile third-party pharmacy remittances, EFTs, and payment activity to prescription dispensing records.
• Research and resolve unapplied, unresolved, and exception-based payment activity.
• Coordinate with pharmacy personnel, PioneerRX and ProviderPay to resolve reimbursement discrepancies.
• Monitor pharmacy third-party accounts receivable aging and investigate outstanding reimbursement balances.
• Maintain payer enrollment records, EFT information, ERA relationships, BIN/PCN records, and related payer documentation.
• Assist Finance with month-end close processes related to pharmacy operations.
• Perform monthly reconciliation of pharmacy revenues, expenses, inventory, retail claims and 340B savings.
• Review reimbursement trends and identify underpayments, payment variances, and operational trends, and communicate findings and recommendations to leadership.
• Generate recurring and ad hoc financial, reimbursement, utilization, operational reports and dashboards from PioneerRx and related systems.
• Assist with maintenance of pharmacy-related financial policies, procedures, and internal controls.
• Support annual audit requests and financial reporting requirements involving pharmacy operations.
• Serve as a liaison between Pharmacy Operations, Finance, Revenue Cycle, third-party payers, and pharmacy vendors to support reimbursement, payment reconciliation, reporting, and operational support activities.
• Assist with implementation of upcoming 340B Rebate (Pilot) model.
• Generate and review daily VaxCare transaction reports to identify vaccine-related claims requiring billing review and follow-up.
• Review vaccine claim activity and determine whether claims are the responsibility of VaxCare or The Wright Center based on established program guidelines and payer requirements.
• Coordinate and maintain vaccine-related billing hold workflows within Medent and other applicable systems until billing responsibility is verified.
• Identify and track Partner Claims requiring submission through The Wright Center's billing processes and coordinate with Revenue Cycle staff to ensure timely billing and reimbursement.
• Research and resolve vaccine billing exceptions, discrepancies, and claim classification issues in collaboration with Revenue Cycle, Clinical Operations, Pharmacy, and VaxCare representatives.
• Maintain supporting documentation and audit trails related to vaccine billing determinations, billing holds, and reimbursement activity.
• Monitor pending vaccine claims and ensure timely follow-up and resolution of outstanding billing responsibility determinations.
• Generate and maintain reports related to vaccine billing activity, claim routing, reimbursement status, and operational performance metrics.
• Collaborate with Pharmacy Operations, Revenue Cycle, Clinical Operations, and Finance leadership to improve workflows and controls.
• Identify process improvement opportunities related to reimbursement, reconciliation, reporting, and financial operations.
• Develop and maintain standard operating procedures related to assigned responsibilities.
• Participate in special projects and other duties as assigned.