Pharmacy Business and Revenue Cycle Specialist (IL) - Prime Healthcare Management Inc

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 45 hospitals and has more than 300 outpatient locations in 14 states providing more than 2.6 million patient visits annually. It is one of the nation’s leading health systems with nearly 50,000 employees and physicians. Fourteen of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

The Pharmacy Business and Revenue Cycle Specialist is responsible for ensuring that pharmacy related systems and processes for revenue cycle are maintained to optimize reimbursement potential and meet all local, state and federal rules and regulations. This specialist will serve as the primary point of contact for all pharmacy billing and coding related questions. This specialist will also aid the pharmacy team in understanding and analyzing the appropriateness of reimbursement including, but not limited to, denials evaluation, underpayment review, appeals generation and claim generation process breakdowns. This position will collaborate with key stakeholders to develop appeals or redeterminations for any claims that require a review of medical necessity, disease state coding, etc. This position will collaborate closely with IT analysts to understand process breakdowns and lead assigned projects. Additionally, this position will be responsible for designing, maintaining, and conducting education of front-line staff of all revenue cycle management activities under their purview.

EDUCATION, EXPERIENCE, TRAINING

Required qualifications:

1.    At least 3 years of experience in Pharmacy Informatics, Infusion Pharmacy or Hospital Pharmacy

2.    Experience with medication billing in the inpatient hospital and outpatient infusion areas

3.    Strong verbal and written communication skills as well as data analytics skills required.
 

Preferred qualification:

1.    B.S. in Pharmacy or PharmD degree preferred.

2.    Work experience as a hospital or infusion pharmacist preferred.

3.    Experience in 340B program operations and compliance preferred.

4.    Proficiency in EPIC and Meditech electronic medical records (EMR) system preferred.

5.    Advanced knowledge and experience in pharmacy revenue cycle management preferred.

6.    Proficiency in data analysis preferred.

7.    Experience developing and implementing operational processes preferred.

8.    Experience with Charge Description Master maintenance preferred.