Consultant | Healthcare Performance Improvement | Pharmacy and Clinic Services
2 days ago
The Healthcare Consulting Performance Improvement team is looking for a Consultant to join the team in supporting clients in the Pharmacy and Clinic Services space specifically as it relates to compliance, program optimization, and financial performance.
How you will contribute:
- Assist with Financial/Reimbursement assessments to determine reimbursement opportunities for on-campus and off-campus provider-based departments as well as freestanding and provider-based Rural Health clinics.
- Responsible for the financial analysis proactive calculations and modeling of new regulatory changes and impacts
- Assist with PowerPoint presentation reports
- Assist with developing provider-based strategy, gap assessments, and transition advisory processes. Provide guidance to clients regarding provider-based departments.
- Operational Assistance
- Split-billing (technical/professional)
- Chargemaster requirements
- CMS Provider-Based Clinic regulations and Federal and State regulations
- Compliance with provider-based rule requirements
- CMS Checklists
- Assimilate provider-based checklists (attestations)
- Assist with transitions to Rural Health Clinic (RHC) or Provider Based RHC
- Policy and Procedure Development
- Survey readiness assistance
- Become proficient in provider-based (42 CFR 413.65) and RHC regulations and stay abreast of ongoing legislative changes.
- Prepare Medicare RHC cost reporting schedules.
- Calculating RHC visits
- Calculating FTEs for productivity
- Provide guidance to clients regarding their 340B and other pharmacy operations:
- Policy and Procedure Development
- 340B network expansion i.e., development of contract pharmacy arrangements, child sites, direct purchases, orphan drugs, and other opportunities
- Operational Assistance
- Split-billing vendor implementations
- Split-billing vendor maintenance i.e., Drug Crosswalk Maintenance
- Compliance Reviews
- Independent Reviews
- HRSA Audit Experience a plus
- Advise, communicate, and present to all levels including C-suite, management, and clinic staff.
- Provide in-depth provider-based processes and regulatory knowledge to clients.
- Provide an unmatched client experience and identify additional value-added services
- Active participant in specific healthcare industry groups (Becker's, Apexus, 340B Health, HFMA, etc.)
- Strong analytical and communication skills
- Ability to deliver work products consistently and with high-quality.
- Demonstrated ability to think independently and train other team members as needed.
- Ability to travel up to 50%, depending on client commitments.
- Highly motivated and self-driven to exceed client needs and timelines.
- Bachelor's degree in Business, Accounting, Finance, Health Services Administration, or a related field
- 2 years or more of experience working within the healthcare industry, specifically consulting or with a hospital
- Significant experience in advanced Excel, IT platforms, and healthcare
- Strong technical skills, experience with spreadsheets, databases, and an automated audit work paper system
- Experience with project management
Preferred Qualifications:
- Experience in the following areas:
- Healthcare provider-based billing
- Provider-based attestation compliance and submission to Medicare
- Medicare/Medicaid Hospital cost reporting
- Practice operational knowledge in provider-based physician practices, or RHCs.
- EPIC
- Data visualization (Tableau or Power BI)
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