Financial Pharmacy Analyst
Men’s Health Foundation connects men at risk to comprehensive healthcare and wellness through education, collaboration and advocacy, inspiring and empowering all men to live longer, healthier and happier lives. We see a world where inequity and stigma do not separate men from healthcare. At Men’s Health Foundation we are reimagining men’s healthcare.
Reporting to the Chief Pharmacy Officer (CPO) and Director of Pharmacy Operations the Pharmacy Analyst is responsible for operational development and management of revenue cycle functions of the pharmacy, which include but are not limited to: patient financial services, revenue integrity, charge capture, billing, claims management, collections, denial management and medical records reconciliation. The Pharmacy Analyst also coordinates daily with other pharmacy staff and interdepartmental teams to ensure efficient pharmacy operational flow through high levels of accuracy, teamwork, and customer service.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: (This list may not include all of the duties assigned.)
• Analyze 340B purchases and pricing and compare to national 340B database to ensure correct pricing.
• Run quarterly reports at the beginning of each quarter to ensure that any new (esp. high dollar) drugs released 3 calendar quarters earlier are refunded for over payments over the preceding 3 quarters.
• Track pharmacy invoicing to ensure prompt and appropriate bill paying.
• Reconciles claims in NetRx and PioneerRx system with bank deposits received.
• Prepares interdepartmental billing for month-end.
• Ensures 340B compliance with financial record-keeping related to 340B purchases.
• Perform regular billing audits to ensure billing accuracy.
• Track and trend DIR fees assessed and communicate to finance for accounting purposes.
• Manage and respond to 3rd party financial audits as needed.
• Work with finance department to ensure 340B program income allocation compliance.
• Works directly with stakeholders on revenue cycle performance to meet short term and long term strategic goals.
• Compiles various reports including various statistics or metrics requested by upper management
• Enhances and standardizes workflow throughout the Revenue Cycle. Creates policies and procedures in accordance with implementation of all work processes. Cross trains team members.
• Designs and develops training programs and manuals that are relevant and necessary for the continuous development of the technical competencies
• Identifies and corrects operating issues that will maximize the effect on cash flow and mitigate financial or operational risks.
• Oversees external billing company and serves as MHF’s liaison to streamline operations and increase billing accuracy and patient experience.
• Establish and oversee financial/business dashboard and month-end packet for accounting.
• Other duties in the pharmacy operations may be assigned, as required.
• Experience in Revenue Cycle environment or other finance-related disciplines preferred
• Bachelor’s degree in finance, business, healthcare administration or other related field, or equivalent combination of education and experience.
• Strong background in medical or pharmacy billing concepts.
• Knowledge of PSAOs, retail pharmacy operations and understanding of pharmacy claims data and reimbursement preferred.
• Knowledgeable of applicable state and federal regulations preferred
• Familiarity with NCPDP claims, pricing matrixes and reimbursement terms.
• Excellent written and verbal communication skills
• Able to prioritize effectively and meet strict deadlines while managing multiple, competing tasks in a fast-paced organization.
• Knowledge of Microsoft Office Suite; Microsoft Word; Microsoft Excel;; internet software;
• Basic operation of a workstation (turning on/off, knowledge of basic functions and components).
• Computer-related problem-solving skills through the use of available trainings and help desk.
• Clinic experience preferred.
• Call center experience preferred.
• PioneerRx and/or Allscripts EHR experience preferred.
• Combination of the following preferred:
o Certified Coding Specialist (CCS) or Certified Coding Assistant (CCA) or Certified Professional Coder (CPC).
o Certified Professional Biller (CPB).
o Registered Health Information Technologist (RHIT) or Registered Health Information Administrator (RHIA).
• Must be able to pass a pre-employment drug test as well as background check to include a 7-year criminal, 10-year SSN & employer history reference check.
• Excellent interpersonal skills.
• Attention to detail.
• Must be able to work flexible schedules.
• Must take yearly flu shot or wear mas during flu season and test yearly for tuberculosis as required by the Centers for Disease Control and Prevention.