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Pharmacy Reimbursement Specialist 2, Clinic Technician, Hybrid

2 months ago

Nashville, United States Vanderbilt University Medical Center Full time

Discover Vanderbilt University Medical Center: Located in Nashville, Tennessee, and operating at a global crossroads of teaching, discovery, and patient care, VUMC is a community of diverse individuals who come to work each day with the simple aim of changing the world. It is a place where your expertise will be valued, your knowledge expanded, and your abilities challenged. Vanderbilt Health recognizes that diversity is essential for excellence and innovation. We are committed to an inclusive environment where everyone has the chance to thrive and where your diversity of culture, thinking, learning, and leading is sought and celebrated. It is a place where employees know they are part of something that is bigger than themselves, take exceptional pride in their work and never settle for what was good enough yesterday. Vanderbilt’s mission is to advance health and wellness through preeminent programs in patient care, education, and research.

Organization:

Pharmacy Complex Care Tech Coo

Job Summary:

JOB SUMMARY

Evaluates reimbursement of medications provided to inpatients, clinic patients and patients receiving prescriptions through the outpatient pharmacy network. Works with multidisciplinary groups to develop proper procedures and programs to maximize reimbursement. Facilitates process and system improvements to reduce the likelihood of occurrence of loss of reimbursement relating to pharmaceuticals. Assists with maintaining drug and payer data files in the dispensing system. Works with dispensing staff and/or Payor Help Desk Staff to troubleshoot issues with medication claims &, when needed, editing / resubmitting claims in the OP dispensing system.

.

KEY RESPONSIBILITIES

• Clarify and trend pharmaceutical denials and underpayments of the highest cost drugs and other drugs.

• Utilizes data from finance and pharmacy systems to determine reimbursement rates for pharmaceuticals for various patient care settings.

• Evaluates actual reimbursement compared to defined contractual reimbursement rates for specific drugs/procedures.

• Provides trending on reimbursement and information on areas for focus to maximize reimbursement.

• Maintains data in appropriate database to facilitate evaluation and presentation of data.

• Evaluates data enabling the identification of trends by multiple variables.

• Work with patient accounting, finance, contracts and pharmacy to develop strategy for improved reimbursement.

• Utilizing data collected, defines areas for focus to maximize reimbursement and presents plan to above departments.

• Maintains list of potential opportunities for reimbursement and contracting based on proactive review of data.

• Works collaboratively to develop programs and procedures to maximize reimbursement of pharmaceuticals.

• Facilitates process and system improvements to reduce the likelihood of occurrence of loss of reimbursement relating to pharmaceuticals.

• Works with pharmacy staff and finance to evaluate reimbursement of new drugs and proposes necessary procedures to maximize reimbursement.

• Document enhanced reimbursement from developed programs and trend success of programs.

• Utilizing databases maintained to provide documentation to support the effectiveness of the reimbursement program. Assists with regulatory compliance related to safe medication use with program, operational, regulatory bodies (JCAHO, ASHP, state and federal regulations, Leapfrog, etc.), and institutional policies and procedures.

• Provides written monthly update on activities and financial impact of program to enhance reimbursement.

• Assists billing manager and documents regulatory compliance related to billing of pharmaceuticals and works to correct any variances.

• Work with Patient Assistance Programs (PAP) to include identifying new opportunities, document receipt of funds and provide proper adjustment of patient accounting accounts.

• Collaborates with pharmacy, finance, contracts and patient accounting to identify ongoing opportunities to expand the PAP to reduce drug cost.

• Documents savings from the PAP and provides a monthly report trending the savings from the program.

• Provide recommendations to pharmacy administration for input into hospital contracting for enhanced reimbursement.

• Maintains proper resources and contacts to understand the contractual reimbursement of pharmaceuticals.

• Maintains documentation on any issues with contractual reimbursement including the financial impact for review by pharmacy, finance and contracting.

• Contributes to the continuing education of pharmacy on the reimbursement of pharmaceuticals and the contractual trends for reimbursement.

• As permitted by law, may receive or transfer oral prescriptions for dispensed medications under the supervision of a pharmacist.

TECHNICAL CAPABILITIES

Our professional administrative functions include critical supporting roles in information technology and informatics, finance, administration, legal and community affairs, human resources, communications and marketing, development, facilities, and many more.

At our growing health system, we support each other and encourage excellence among all who are part of our workforce. High-achieving employees stay at Vanderbilt Health for professional growth, appreciation of benefits, and a sense of community and purpose.

Core Accountabilities:

  • Organizational Impact: Performs non-routine tasks that significantly impact team's performance with minimal guidance. * Problem Solving/ Complexity of work: Conducts research and analysis to solve some non-routine problems.* Breadth of Knowledge: Applies broad job knowledge and has basic job skills in other areas.* Team Interaction: Provides informal guidance and support to less experienced team members.

Core Capabilities :

Supporting Colleagues: - Develops Self and Others: Continuously improves own skills by identifying development opportunities.- Builds and Maintains Relationships: Seeks to understand colleagues' priorities, working styles and develops relationships across areas. - Communicates Effectively: Openly shares information with others and communicates in a clear and courteous manner. Delivering Excellent Services: - Serves Others with Compassion: Invests time to understand the problems, needs of others and how to provide excellent service. - Solves Complex Problems: Seeks to understand issues, solves routine problems, and raises proper concerns in a timely manner. - Offers Meaningful Advice and Support: Listens carefully to understand the issues and provides accurate information and support. Ensuring High Quality: - Performs Excellent Work: Checks work quality before delivery and asks relevant questions to meet quality standards.- Ensures Continuous Improvement: Shows eagerness to learn new knowledge, technologies, tools or systems and displays willingness to go above and beyond.- Fulfills Safety and Regulatory Requirements: Demonstrates basic knowledge of conditions that affect safety and reports unsafe conditions to the appropriate person or department. Managing Resources Effectively: - Demonstrates Accountability: Takes responsibility for completing assigned activities and thinks beyond standard approaches to provide high-quality work/service. - Stewards Organizational Resources: Displays understanding of how personal actions will impact departmental resources. - Makes Data Driven Decisions: Uses accurate information and good decision making to consistently achieve results on time and without error. Fostering Innovation: - Generates New Ideas: Willingly proposes/accepts ideas or initiatives that will impact day-to-day operations by offering suggestions to enhance them. - Applies Technology: Absorbs new technology quickly; understands when to utilize the appropriate tools and procedures to ensure proper course of action. - Adapts to Change: Embraces changes by keeping an open mind to changing plans and incorporates change instructions into own area of work.

Position Qualifications:

Responsibilities:

Certifications:

LIC-Pharmacy Technician - Tennessee

Work Experience:

Relevant Work Experience

Experience Level:

2 years

Education:

Graduate of an approved discipline specific program

Vanderbilt Health recognizes that diversity is essential for excellence and innovation. We are committed to an inclusive environment where everyone has the chance to thrive and to the principles of equal opportunity and affirmative action. EOE/AA/Women/Minority/Vets/Disabled