Pharmacy Manager – Revenue Cycle – Remote, FT Days

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Day – 08 Hour (United States of America)

This is a Stanford Health Care job.

A Brief Overview

The Manager for Pharmacy Revenue Cycle reports to the Senior Director of Pharmacy Business Operations and is responsible for development and execution of Pharmaceutical Revenue Cycle program initiatives. The Manager works with stakeholders across the broader Stanford Health Care organization to drive operational and strategic change and is accountable for leading a portfolio of projects designed to optimize the financial health of Stanford Health Care.

Locations

Stanford Health Care

What you will do

CORE RESPONSIBILITIES

Provides leadership in all components Pharmaceutical Revenue Cycle Services within the Pharmacy department.

Leads and strategizes new pharmaceutical product launches and optimize outcomes with numerous external stakeholders.

Provides Pharmaceutical Revenue Cycle guidance as well as leadership in identifies program initiatives in alignment with SHC Revenue Cycle strategic objectives.

Actively participates in strategic committee discussions and activities and takes a leadership role in organizing projects or initiatives to support committee goals.

Serves as a Revenue Cycle methodology expert on pharmaceutical charges, pricing, costing.

Provides performance improvement methodology guidance on Pharmaceutical Revenue Cycle operations to pharmacy and external leaders.

Contributes to positive business results by maintaining a workplace characterized by high performance, mutual support and respect, and teamwork.

Regularly searches for and identifies opportunities for quality and process improvement, resulting in improved efficiency and increased productivity.

Collaborates with the Pharmacy Finance team to align with revenue projections and budget compilation.

Provides support for Strategic Pricing Executive Council, Strategic Pricing-Finance, and Managed Care for payor negotiations, audit, and pricing compliance.

Provides program leadership for large strategic and cross-functional workflow initiatives by defining project scope, engaging stakeholders, and managing project timelines and deliverables.

Develops appropriate KPIs and drafts suitable dashboard managers for each work stream and fully scopes the pharmacy revenue cycle process to identify opportunities, define resource needs, understanding both inpatient and outpatient pharmacy operations, as well as pharmaceutical procurement, clinical approval processes, charge generation, and 340B costing.

Serves as Pharmacy Department expert on matters related to commercial and government payment terms for pharmacy related services.

ADDITIONAL TASKS AND PROJECTS

Drives Pharmacy Pricing, Costing, and Claims experience with SHC partners such as Organizational Finance, Revenue Cycle, Managed Care, and Case Management.

Supports Pharmacy departmental initiatives by monitoring, tracking, reporting, and problem-solving related to high-cost drug coding, charging, and reimbursement.

Improves payment denials and underpayments experienced in pharmaceuticals by working with Pharmacy stakeholders and SHC Revenue Cycle and Compliance teams.

Improves and drives efficiency on current waste billing and Charge Queue experience.

Builds positive working relationships across the organization; engages effectively with staff, management, and senior leadership in project work.

Develops and supports executive-level presentations and statuses for senior leadership, while delivering presentations on Revenue Cycle programs and initiatives to various audience levels.

Performs financial and operational data analysis in support of organizational and project-level objectives.

Provides support for Pharmaceutical Revenue Cycle strategic planning efforts.

Assists in identifying key revenue cycle items, processes, and updates for consideration.

Keeps leadership informed with verbal and written updates on pharmacy revenue cycle issues or opportunities.

Performs various audits to validate processes and compliance throughout the revenue cycle.

Works with management and leadership to improve collections, reduce accounts receivable, minimize denials, and decrease avoidable write-offs through issue identification, research, communication, and process improvement.

Collaborates with internal and external department to develop and document department policy and procedures.

Acts as the point person for coding, billing, claim review, denial management, referrals, authorization management, and patient and insurance payments, while also providing hands-on support to the team with daily tasks as needed.

Maintains active knowledge of CMS guidelines, contracted insurance guidelines, and coding policies for pharmaceuticals, while possessing a thorough understanding of ICD, CPT, and HCPCS coding principles for pharmaceuticals.

Maintains a strong working knowledge of the system(s) used and is prepared to provide support to staff and management when requested.

Fosters relationships, internally and externally, to include, but not limited to, practices.

Trends and analyzes denials and front-end failed claims for training and development of clinic staff and revenue cycle team.

Monitors Pharmaceutical worklists and buckets with the EHR and delegate accordingly.

Maintains an understanding of processes and procedures for improvement initiatives as it applies to pharmaceutical revenue cycle workflows.

Ensures annual audits of providers and staff as needed to ensure accurate and timely coding and billing activities.

Reports out to Managed Care, on a quarterly basis, projections of new drugs that might require special pricing considerations and reimbursement trends of current drug carve-out terms in the commercial agreements.

Performs other pharmaceutical revenue cycle-related duties as assigned, which may not be outlined above.

MANAGERIAL FUNCTIONS

Attends workshops, seminars, and conferences to stay abreast of standards and best practices within the field; disseminates relevant information to colleagues and staff as appropriate.

Responsibilities include (but are not limited to): Interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints; and resolving root causes of issues.

Encourages and assists with the ongoing development and education of staff, while managing ongoing user training for new hires and existing business office staff to ensure systems are utilized to their fullest capabilities.

Provides focused pharmacy revenue cycle-related education to various clinical, financial, operational, and other stakeholders as needed.

Supervises the performance and provides evaluation of the Revenue Cycle operations team and business office.

Assists with the development, implementation, and monitoring of quality assurance reviews for staff and providers.

Provides continuing education regarding insurance carrier changes and updates.

Education Qualifications

Bachelor’s degree in health care, Finance, Business Administration, or a related field.

Advanced degree such as Masters, MBA, JD, PharmD is desired.

Experience Qualifications

5-7 years of progressively responsible and directly related work experience in pharmacy-related areas, with an understanding of overall pharmaceutical revenue cycle management, billing, insurance claim follow-up, and denial management processes.

A minimum of 5 years of managerial and/or supervisory experience is required.

Advanced knowledge of pharmaceutical revenue cycle operations preferred.

Required Knowledge, Skills and Abilities

A strategic understanding and broad view of hospital revenue cycle operations.

Understanding of pharmacy business and finance operations.

Business and financial management, including the ability to analyze data for operations, budgeting, auditing, and forecasting.

Excellent interpersonal skills, with a demonstrated ability to work with a wide variety of people, both within the organization and externally.

Demonstrated ability to interact effectively with peers and subordinates.

Demonstrated quantitative analytical skills.

Demonstrated organization and planning skills.

Demonstrated knowledge and understanding of Lean, project management, and/or Six Sigma principles and their applications.

Demonstrated ability to work independently and complete assignments effectively.

Excellent computer skills in a Microsoft Windows environment, including intermediate proficiency in Excel.

Excellent organizational skills.

Ability to plan, organize, and effectively lead multi-disciplinary teams and projects, delivering meaningful results within established time frames.

Ability to act as a thought leader for performance improvement and pharmaceutical revenue cycle methodologies.

Ability to communicate effectively at all organizational levels, both orally and in writing

Ability to establish and maintain effective relationships with widely diverse groups, including individuals at all levels both within and outside the organization.

Ability to motivate, influence, and direct the work of others.

Ability to resolve conflicts and/or negotiate with others to achieve positive results.

Ability to work well both autonomously and as a team player.

Flexible and adaptable to change while working in a fast-paced environment.

Licenses and Certifications

RPH – Registered Pharmacist .

These principles apply to ALL employees:

SHC Commitment to Providing an Exceptional Patient & Family Experience

Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.

You will do this by executing against our three experience pillars, from the patient and family’s perspective:

Know Me: Anticipate my needs and status to deliver effective care

Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health

Coordinate for Me: Own the complexity of my care through coordination

Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.

Base Pay Scale: Generally starting at $81.53 – $108.02 per hour

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.

At Stanford Health Care, we seek to provide patients with the very best in diagnosis and treatment, with outstanding quality, compassion and coordination. With an unmatched track record of scientific discovery, technological innovation and translational medicine, Stanford Medicine physicians are pioneering leading edge therapies today that will change the way health care is delivered tomorrow.

As part of our spirit of discovery, we also leverage our deep relationships with luminary Silicon Valley companies to develop new ways to deliver preeminent patient care.

Learn about our awards (https://stanfordhealthcare.org/about-us/awards.html) and significant events (https://stanfordhealthcare.org/about-us/our-history.html) .