Pharmacy Billing and Reimbursement Manager

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:

Pharm Billing & Pt Svcs

Job Summary:

Manage the systems that support the Pharmacy Revenue Cycle team. Monitor, maintain, & improve the billing systems, collection systems, processes, databases, and pharmacy employees' performance that impact pharmacy revenue cycle workstreams. Work collaboratively with other VUMC staff to make sure the pharmacy revenue cycle systems (i.e. medication charge master, pharmacy dispensing system, pharmacy collection system, point of sale receipt system) interact properly with other VUMC computer systems. Is responsible for making sure that pharmacy revenue cycle procedures are in compliance with all applicable government regulations. Work with various VUMC staff to ensure proper charging and adequate payments are received for drug charges. Since pharmacy charges account for about 20% of the total hospital's revenue stream (more than any other single department), this employee's performance has a major and direct impact on VUMC's financial success.

This position will manage the Pharmacy Revenue Cycle’s High-Cost Drug Prior Authorization teams. To be a successful in this position, experience with the following would be helpful
• Payer portals
• Payer medical policies for drugs
• Pharmacy verus Medical benefit investigations
• Prior authorization elements
• Epic experience

The successful candidate will also have great communication skills both written and spoken.

.

KEY RESPONSIBILITIES
•     Manage the performance of the Pharmacy's revenue cycle systems to ensure the accurate and timely billing of drugs and collection of reimbursement from payers and patients. Decide on needed system improvements & implement such changes. Work with departmental and VUMC leadership to develop and implement new pharmacy revenue cycle procedures.
•     Supervises the daily performance of Pharmacy revenue cycle systems. This includes computer systems, databases, and staff performance. Identifies problems & errors & takes corrective action.
•     Decides when new drug files are needed based on an in-depth knowledge of drugs, Pharmacy procedures, and the Pharmacy charge system. Gathers more information from both staff members and reference material as needed. Then uses own judgment to properly assign fees to new drug files.
•     Works collaboratively with other Pharmacy staff when creating new drug files and CDMs to ensure charges generate appropriately.
•     Works collaboratively across departmental lines with senior departmental and VUMC leadership to respond to problems. Develops and implements solutions.
•     Review and apply regulatory and legal requirements to ensure compliance with all applicable governmental regulations regarding Pharmacy billing and collecting. Work collaboratively with the Compliance office, Finance, Patient Accounting, and others to fulfill this responsibility.
•     Reviews and researches governmental laws, rules, and regulations that relate to billing of drugs. These include CPT coding requirements, what drugs can or can not be billed, the required billing formats, etc.
•     Performs this responsibility on an ongoing basis. Reviews the appropriate manuals, which are updated. Also, continually reviews CMS's and other groups' web sites to stay updated on new information and rules released on an ongoing basis.
•     Has billing responsibility for all retail Pharmacy drugs that are used throughout VUMC. Works collaboratively with leadership to implement and maintain the drug database.
•     Determines the need for software changes to the P