Lead Pharmacist

Lead Pharmacist (Revenue Intergrity)A Brief OverviewThe Pharmacy Lead Pharmacist is responsible for maintenance and enhancement of revenue and its associated compliance activities within Pharmacy Services. The position requires collaboration with Finance, Billing, Compliance, Providers, Pharmacy and Patient Care Services.What you will do1. Assists in coordinating daily department activities in accordance with established policies and procedures to facilitate efficient pharmacy operations and ensure that patient care objectives are maintained. Assists in the formulation and implementation of department procedures and policies. a. Reviews work orders to prioritize activities and promote efficient operation of Pharmacy area in the billing and reconciliation of medication revenue reconciliation; expedites activities as needed. b. Schedules and assigns work to employees to ensure adequate service is provided and required duties are completed. Oversees the work of personnel and functions as a resource person for matters related to revenue reconciliation, billing, coding and claims adjustments for medication billing both medical and pharmacy benefit. c. Provides assistance with clinical and technical functions as required. d. Collaborates with Director to facilitate assignment of new employees for in-service instruction and orientation. 2. Confers and works collaboratively with medical/hospital staff and others in a customer responsive and courteous manner, in compliance with Premier standards and promoting patient/customer satisfaction to achieve positive patient outcomes. 3. Serves as a Pharmacy liaison and resource, exchanging information with nursing/clinic staff and physicians. Answers inquiries; communicates and interprets policies, procedures and standards of practices to staff/patient/family/visitors to promote understanding and ensure consistency in the application of policies and procedures. a. Interprets pharmacy goals, policies and procedures. b. Investigates and answers queries from physicians, nursing staff and patients/families regarding pharmacy services. c. Resolves complaints, conflicts and operational problems. Informs Pharmacy Director/Leadership of any problems or issues which cannot be resolved or require intervention. 4. Operates computerized data systems. a. Interprets and performs order entry functions in accordance with departmental policies and procedures. b. Utilizes computer software applications to obtain drug information and billing documents. c. Operates computer and related equipment to enter and retrieve information. 5. Maintains required department records, reports and files for administrative, operational and compliance purposes. a. Compiles and prepares various reports and data, collates and assembles reports and documents as required. b. Generates statistics, computations, tables, or charts as required. c. Utilizes analytic skills and statistical analysis to aggregate data to assist with the identification of potential problems and patterns, trends, establish priorities and recommend improvement activities. 6. Maintains confidentiality in matters relating to patient/family, department and hospital information. Adheres to established department and organization policies (i.e. HIPAA, Confidentiality, and Compliance Policies). 7. Monitors and maintains department budget/purchasing records, grants, and contracts to meet patient needs and financial goals of Pharmacy Services. a. Assists in development and maintenance of department's budget. b. Ensures charges are accurately captured for pharmaceutical, supplies and other items provided. c. Applies cost effective measures and utilizes defined departmental procedures to allocate resources related to manpower, supplies and inventory. Assists with maintenance and care of department equipment. 8. Participates in quality/performance improvement. a. Responds to problems/opportunities to improve work environment and participates in department and hospital performance improvement activities which includes committees, monitoring and follow-up. b. Represents department and participates on various hospital/clinic committees. c. Collects quality data for monitoring performance improvement and to produce the best value service. 9. Completes required continuous training and education, including department specific requirements. Maintains professional credentials and education necessary to keep abreast and maintain a current knowledge of clinical/theoretical principles, concepts and techniques. Attends and actively participates in meetings, conferences, and seminars for the purpose of enhancing professional skills and sharing information on recent developments in fields of pharmacology and pharmaceutics. 10. Oversight of Medication billing for medical and pharmacy benefit claims. a. Submits and audits claim submissions to third party payors. b. Assesses marketing and growth opportunities for the Ambulatory Pharmacy. c. Contacts providers concerning prior authorization and medical necessity drugs for third party insurers and nonformulary medication orders. d. Maintains knowledge of insurance plans, medication assistance program drugs and guidelines to promptly process prescriptions. e. Responds to customer/patient inquiries. f. Provides professional leadership for revenue cycle and billing compliance program within Pharmacy Services g. Ensures routine review and reporting related to revenue cycle management h. Reviews, analyzes and implements process improvements in operational areas related to billing compliance and payer contracts. i. Ensures optimization of revenue capture. j. Works with Finance departments to ensure appropriate pricing and reimbursement of Pharmacy Services k. Establishes and monitors policies and procedures related to cash management and billing compliance. Ensure the effective implementation of adopted polices and procedures. l. Develops and produces routine reports to ensure close monitoring of revenue cycle. Prepare management reports that provide Pharmacy leadership with timely and relevant information on all aspects of revenue, compliance and audit issues m. Works with Pharmacy Compliance and Audit manager and Compliance officers to plan routine audit functions related to billing compliance. n. Participates in teaching activities for Pharmacy residents and students. o. Perform related duties as required.Coordinates and audits cashiering functions.Submits and audits claim submissions to third party payors.Instructs/Counsels patients in the use of medications, assistance program, side effects, special precautions, missed doses, etc. when indicated.Assesses marketing opportunities for the Medplex Pharmacy.Contacts providers concerning prior authorization and medical necessity drugs for third party insurers and nonformulary medication orders.Checks patient identification and issues filled medication to outpatients.Provides assistance to customers/patient in the purchase of over-the-counter items.Maintains knowledge of insurance plans, medication assistance program drugs and guidelines to promptly process prescriptions.Responds to customer/patient inquiries.QualificationsGraduate of an accredited Pharmacy, M.S., and/or Pharm D program. ASHP Residency preferred. Required andQualified by education, training or experience to work with the neonate, infant, adolescent, adult, and/or geriatric patient population as specialty assignment dictates RequiredCurrent Tennessee licensure as a Pharmacist Upon Hire Required andAdditional certification may be required based on assignment Upon Hire RequiredMinimum 1 year experience as a Pharmacist RequiredPhysical DemandsStanding - ConstantlyWalking - ConstantlySitting - RarelyLifting - FrequentlyCarrying - FrequentlyPushing - OccasionallyPulling - OccasionallyClimbing - OccasionallyBalancing - OccasionallyStooping - FrequentlyKneeling - FrequentlyCrouching - FrequentlyCrawling - OccasionallyReaching - FrequentlyHandling - FrequentlyGrasping - FrequentlyFeeling - ConstantlyTalking - ConstantlyHearing - ConstantlyRepetitive Motions - ConstantlyEye/Hand/Foot Coordination - ConstantlyRegional One Health is committed to diversity and inclusion. We are an equal opportunity employer including veterans and people with disabilities.