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Associate Pharmacy Analyst
4 months ago
The primary focus of the position is to support the operational efficiency of the Pharmacy Department by coordinating fiscal management activities, performing data analysis and maintaining departmental statistics and reports. Data base development, project management, cost accounting, and IT skills will be employed to work with clinical pharmacists, residents, medical staff, and pharmacy administration. Direct work with patients and/or insurances may be involved to assist with coordinating information needed to qualify them for coverage or financial assistance.
MINIMUM QUALIFICATIONS:
EDUCATION, EXPERIENCE, CERTIFICATION, AND/OR LICENSURE:
1. Bachelor degree in Information Technology, Business Management, Hospital Administration, Accounting, or Finance
OR
Associates degree in Information Technology, Business Management, Hospital Administration, Accounting, or Finance and Two (2) years of experience of pharmacy experience one or (1) year of experience with financial reporting
OR
High School Diploma and Nationally Certified Pharmacy Technician within 15 months of hire and five (5) years' experience in a healthcare setting
PREFERRED QUALIFICATIONS:
EXPERIENCE:
1. Direct experience in medical billing, coding, or prior authorizations.
2. Direct experience in enrolling patients in medication or copay assistance programs.
3. Direct Experience in healthcare informatics.
CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.
1. Monitors daily medication charges to ensure correct documentation and charging and correct discrepancies found.
2. Facilitates the addition, deletion, or correction of charges and coding to the charge master as needed.
3. Assures utilization of all available indigent care programs for inpatient and outpatient administration of medications.
4. Coordinates with Clinical Specialists to prioritize medication authorizations and patient assistance needed.
5. Identifies patients requiring medication pre-certification or prior authorization at the time services are requested or when notified by clinical staff.
6. Contacts insurance company or employer to determine eligibility and benefits for requested services.
7. Proactively assists in researching departmental issues and involves proper information technology, contracting, or finance personnel to resolve issues as needed.
8. Maintains database of major payer payment provisions and regulations.
9. Optimizes Enterprise automated systems, researching and analyzing revenue and/or expense opportunities and implementing changes to realize improvements.
10. Assists Pharmacy Analyst with monitoring purchases for contract compliance and accurate pricing.
11. Assists Pharmacy Analyst with monthly budget reviews.
12. Assists Pharmacy Analyst with pulling data needed to compile profile comparisons and generate reports related to current expenses to serve as the basis for the asking budget.
13. Provides scheduled and ad hoc reports as needed to all levels of staff, management, and external agencies.
14. Generates pharmacy spend advisor reports on a monthly basis to ensure that we are purchasing pharmaceuticals in the most cost efficient manner. Communicates those opportunities to Pharmacy Manager & Buyers. Follow up to assist with implementation of changes.
15. Reviews expenditure activity by account by cost centers as expenditures are processed and according to accepted accounting practices and escalates to Pharmacy Analyst for further review if discrepancy found.
16. Identifies irregular spending and system failures related to current expense activity and reports to department Director.
17. Interacts with various hospital departments responsively and productively to promote efficient systems interface and problem resolution related to technological, fiscal, and clinical management as deemed necessary by management
18. Interacts regularly with the department management team and clinical specialists to supply drug usage information, identify irregularities in spending, and provide recommendations for alternative products.
19. Supports Pharmacy, Nutrition and Therapeutics Committee functions by providing financial data to be used in the drug evaluation process, including opportunities for therapeutic interchange of medications.
20. Works with department management in the development and implementation of departmental goals and objectives.
21. Participates in the planning and implementing change and maintaining the improving productivity through attendance and participation in staff meetings, committees, task forces and projects.
22. Participates in the education of other health-care professionals as it pertains to appropriate use and billing of medications.
23. Demonstrates ability to work with staff to resolve problems and obtain necessary documentation for to obtain authorizations and/or assistance approval.
24. Assists Denials Management & Revenue Integrity teams with medication denials and underpayments including appeals based on medical necessity as needed.
25. Monitors medication charges over the maximum daily allowed units and work with Enterprise Medication Utilization Director to resolve trends in discrepancies.
26. Maintains positive working relationships with external vendors such as manufacturers, insurance carriers, government agencies, and insurance provider representatives.
27. Assists with informatics related implementations and maintenance as needed.
28. Reviews monthly automation inventory and provide optimization recommendations to WVUHS pharmacy leadership.
29. Provides reports, data analysis, statistics and required measurement analysis for manufacturers, Insurance agencies, and accreditation bodies as needed.
30. Monitors ordering processes, integrating most current pricing from wholesaler, analyze invoices, shipping, and inventory processes.
PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. While performing the duties of this position, the employee is required to walk and stand for long periods of time.
2. Must be able to lift 30 pounds and must be able to push 50 pounds.
3. Dexterity required to finger, handle, and reach.
WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
SKILLS AND ABILITIES:
1. Extensive working knowledge of Microsoft Office applications Excel & Access.
Additional Job Description:
Position will assist with pricing updates and financial related reporting needs for the Enterprise Pharmacy Warehouse
IN OFFICE MONDAY-FRIDAY, DAY SHIF (MORGANTOWN, WV)
Scheduled Weekly Hours:
40
Shift:
Exempt/Non-Exempt:
United States of America (Exempt)
Company:
SYSTEM West Virginia University Health System
Cost Center:
249 SYSTEM Pharmacy Business Operations
Address:
781 Chestnut Ridge Road
Morgantown
West Virginia
WVU Medicine is proud to be an Equal Opportunity employer. We value diversity among our workforce and invite applications from all qualified applicants regardless of race, ethnicity, culture, gender, sexual orientation, sexual identity, gender identity and expression, socioeconomic status, language, national origin, religious affiliation, spiritual practice, age, mental and physical ability/disability or Veteran status.
