Pharmaceutical Reimbursement Analyst 2

1 week ago

Nashville, Tennessee, United States Vanderbilt University Medical Center Full time

Overview of Vanderbilt University Medical Center: Located in Nashville, Tennessee, VUMC is a hub of teaching, research, and patient care, where a diverse community of professionals strives to make a meaningful impact. At Vanderbilt Health, we believe that diversity is vital for excellence and innovation. We are dedicated to fostering an inclusive environment that celebrates varied cultures, perspectives, and leadership styles, ensuring that every employee feels valued and part of a larger mission. Our commitment is to enhance health and wellness through leading programs in patient care, education, and research.

Department:

Pharmacy Complex Care Tech Coo

Position Summary:

The role involves assessing the reimbursement processes for medications dispensed to inpatients, clinic patients, and those utilizing the outpatient pharmacy services. Collaborating with various multidisciplinary teams, the specialist will develop effective procedures and programs aimed at optimizing reimbursement outcomes. The position also entails facilitating enhancements in processes and systems to minimize the risk of reimbursement losses related to pharmaceuticals. Additionally, the specialist will assist in maintaining accurate drug and payer data within the dispensing system and work closely with pharmacy staff and Payor Help Desk personnel to resolve medication claim issues, including editing and resubmitting claims as necessary.

Key Responsibilities:

  • Analyze and track pharmaceutical denials and underpayments for high-cost medications and other drugs.
  • Utilize financial and pharmacy system data to assess reimbursement rates for pharmaceuticals across various patient care settings.
  • Compare actual reimbursement with established contractual rates for specific drugs and procedures.
  • Provide insights on reimbursement trends and identify areas for improvement.
  • Maintain comprehensive data in relevant databases to support evaluation and reporting.
  • Collaborate with patient accounting, finance, and pharmacy departments to strategize for enhanced reimbursement.
  • Identify potential reimbursement opportunities through proactive data analysis.
  • Work alongside pharmacy and finance teams to evaluate new drugs and recommend procedures to maximize reimbursement.
  • Document and report on the success of reimbursement enhancement programs.
  • Assist in ensuring compliance with regulatory standards related to medication use and billing.
  • Collaborate with Patient Assistance Programs to identify new opportunities and document financial adjustments.
  • Maintain awareness of contractual reimbursement issues and their financial implications.
  • Contribute to the ongoing education of pharmacy staff regarding reimbursement trends and practices.

Technical Skills:

The role requires proficiency in administrative functions that support information technology, finance, legal affairs, human resources, and more. At Vanderbilt Health, we value collaboration and encourage professional growth, offering a supportive environment where employees can thrive.

Core Competencies:

  • Organizational Impact: Engages in tasks that significantly influence team performance with minimal oversight.
  • Problem Solving: Conducts research and analysis to address complex issues.
  • Knowledge Application: Demonstrates broad job knowledge and skills across various areas.
  • Team Collaboration: Provides guidance and support to junior team members.

Position Requirements:

Certifications:

Pharmacy Technician License - Tennessee

Experience:

Minimum of 2 years of relevant work experience.

Education:

Graduate of an accredited discipline-specific program.

Vanderbilt Health is committed to diversity and inclusion, adhering to equal opportunity and affirmative action principles. EOE/AA/Women/Minority/Vets/Disabled

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