Pharmacy Revenue Cycle Manager - Rush University Medical Center
Chicago, IL
About the Job
Job Description
Location: Chicago, IL
Hospital: RUSH University Medical Center
Department: POB Pharmacy
Work Type: Full Time (Total FTE between 0.9 and 1.0)
Shift: Shift 1
Work Schedule: 8 Hr (8:00:00 AM - 4:00:00 AM)
Summary:
This position is responsible for leading the ambulatory pharmacy revenue cycle processes in all Health Delivery Management L.L.C (HDM) outpatient pharmacies with a focus on analyzing, coordinating, and building a scalable charging/reimbursement function for pharmacy services. This includes determining eligibility, verification of benefits, medication prior authorizations, claims adjudication, collection activities with appropriate internal controls and operating metrics. This also includes strict adherence to applicable compliance and regulatory policies, coordination of benefits across primary, and managing the people, processes, and technology from the revenue cycle end-to-end. Exemplifies the Rush mission, vision and values and acts in accordance with Rush policies and procedures.
Responsibilities:
• Is responsible for leading the daily billing cycle in for specialty and home infusion pharmacies, ensuring revenue/charging processes are appropriate and maximized for the benefit of HDM.
• Develops process for payment variance analysis to find unpaid or underpaid claims and corrects issues to have those claims paid or corrected.
• Leads the team to develop systems to avoid unpaid and underpaid claims.
• Manages denial process (identifies denials, corrects them, systematically eliminates them through better front end process or other solutions).
• Is responsible for leading the on-going system maintenance, upgrades, and testing of all pharmacy-related revenue cycle systems or systems that assist in this processes.
• Leads an on-going review process of the negative trends and investigates the root cause of these trends. Recommends actions for corrections. Meets store managers on an as-needed basis to implement and streamline business processes to improve the pharmacy’s bottom line.
• Leads the enhancement of existing revenue cycle systems or business processes, with the focus being to gain efficiencies and improve revenue collections for pharmacy. This includes working closely with the pharmacy managers and senior leaders to enhance and /or eliminate unnecessary manual processes.
• Is overall responsible for the revenue cycle management audits. This includes gathering and providing the required documentations to the auditors.
• Ability to assume other related responsibilities as assigned
Other information:
Required Job Qualifications:
• BA or BS degree.
• Minimum of 3-5 years’ experience overseeing any part of a pharmacy organization’s revenue cycle required. Examples include pharmacy claims billing, pharmacy claims reimbursement, or pharmacy accounts receivable.
• Minimum of 3-5 years’ experience of direct staff supervision
• Strong knowledge of Medicare Part B (DMERC) and IL Medicaid
• Knowledge of pharmaceutical and medical terminology.
• Demonstrates ability with computer and Microsoft tools.
Preferred Job Qualifications:
• Specialty and/or home infusion pharmacy billing experience
• Prior experience in QS1, SystemOne, and CPR+ billing modules
• Experience in PBM payor contracting negotiations
Physical Demands:
• Normal office and clinical environments
Competencies:
Disclaimer: The above is intended to describe the general content of and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities or requirements.
Rush is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.
Position Pharmacy Revenue Cycle Manager
Location US:IL:Chicago
Req ID 9195
Location: Chicago, IL
Hospital: RUSH University Medical Center
Department: POB Pharmacy
Work Type: Full Time (Total FTE between 0.9 and 1.0)
Shift: Shift 1
Work Schedule: 8 Hr (8:00:00 AM - 4:00:00 AM)
Summary:
This position is responsible for leading the ambulatory pharmacy revenue cycle processes in all Health Delivery Management L.L.C (HDM) outpatient pharmacies with a focus on analyzing, coordinating, and building a scalable charging/reimbursement function for pharmacy services. This includes determining eligibility, verification of benefits, medication prior authorizations, claims adjudication, collection activities with appropriate internal controls and operating metrics. This also includes strict adherence to applicable compliance and regulatory policies, coordination of benefits across primary, and managing the people, processes, and technology from the revenue cycle end-to-end. Exemplifies the Rush mission, vision and values and acts in accordance with Rush policies and procedures.
Responsibilities:
• Is responsible for leading the daily billing cycle in for specialty and home infusion pharmacies, ensuring revenue/charging processes are appropriate and maximized for the benefit of HDM.
• Develops process for payment variance analysis to find unpaid or underpaid claims and corrects issues to have those claims paid or corrected.
• Leads the team to develop systems to avoid unpaid and underpaid claims.
• Manages denial process (identifies denials, corrects them, systematically eliminates them through better front end process or other solutions).
• Is responsible for leading the on-going system maintenance, upgrades, and testing of all pharmacy-related revenue cycle systems or systems that assist in this processes.
• Leads an on-going review process of the negative trends and investigates the root cause of these trends. Recommends actions for corrections. Meets store managers on an as-needed basis to implement and streamline business processes to improve the pharmacy’s bottom line.
• Leads the enhancement of existing revenue cycle systems or business processes, with the focus being to gain efficiencies and improve revenue collections for pharmacy. This includes working closely with the pharmacy managers and senior leaders to enhance and /or eliminate unnecessary manual processes.
• Is overall responsible for the revenue cycle management audits. This includes gathering and providing the required documentations to the auditors.
• Ability to assume other related responsibilities as assigned
Other information:
Required Job Qualifications:
• BA or BS degree.
• Minimum of 3-5 years’ experience overseeing any part of a pharmacy organization’s revenue cycle required. Examples include pharmacy claims billing, pharmacy claims reimbursement, or pharmacy accounts receivable.
• Minimum of 3-5 years’ experience of direct staff supervision
• Strong knowledge of Medicare Part B (DMERC) and IL Medicaid
• Knowledge of pharmaceutical and medical terminology.
• Demonstrates ability with computer and Microsoft tools.
Preferred Job Qualifications:
• Specialty and/or home infusion pharmacy billing experience
• Prior experience in QS1, SystemOne, and CPR+ billing modules
• Experience in PBM payor contracting negotiations
Physical Demands:
• Normal office and clinical environments
Competencies:
Disclaimer: The above is intended to describe the general content of and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities or requirements.
Rush is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.
Position Pharmacy Revenue Cycle Manager
Location US:IL:Chicago
Req ID 9195
Source : Rush University Medical Center