Pharmacy Contracting and Revenue Cycle Specialist

MINIMUM QUALIFICATIONS:
EDUCATION, EXPERIENCE, CERTIFICATION, AND/OR LICENSURE:
1. Must possess current license as required by state board where services will be provided:
WV: Pharmacist license through the West Virginia State Board of Pharmacy
EXPERIENCE:
2. Candidates must have experience in at least one of the following areas:
* PGY-1 residency or PGY-2 residency completion
* Two years' experience in Specialty Pharmacy
* Two years' experience in Ambulatory Pharmacy

PREFERRED QUALIFICATIONS:
EDUCATION, EXPERIENCE, CERTIFICATION, AND/OR LICENSURE:
1. PharmD preferred
2. Experience working with specialty pharmacy or home infusion pharmacy
3. Experience with contracting, billing, and revenue cycle management
4. Pharmacy Business, Finance, Billing, or Reimbursement Certifications from an accredited organization such as ASHP, HFMA, or PTCB

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.
1. Assists with contracting and payer relations for the pharmacy by ensuring that contractual requirements are appropriately met, and are up-to-date
2. Assists with establishing appropriate payer/agency reimbursement and payment processes for services rendered.
3. Helps manage revenue cycle processes and documents related to reimbursement
4. Acts as a subject matter expert with payer policy and requirements
5. Builds payer/agency organizations and helps resolve reimbursement/payment issues when they arise
6. Creates analysis for department leaders and works in coordination with business personnel/analysts to provide routine report summaries
7. Develop strategies to address payer/agency variances while continuously advising department leaders
8. Monitors payer performance as it relates to contractual terms and advises compliance with any discrepancies
9. Provides training and education to new employees involved in revenue cycle management or payer relations
10. Provides decision support between department leadership and the finance/accounting/budgeting teams
11. Attends applicable meetings/conferences as required by department leadership
12. Assists compliance/business teams with payer audits or inquiries related to contractual terms and/or reimbursement
13. Helps create efficient process for payer reimbursement or agency payments
14. Advises on and helps resolve payer denials, underpayment, or unbilled charges related to inadequate documentation

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Walk, sit, and stand for long periods of time
2. Normal vision and hearing range
3. Dexterity required to finger, handle, and reach

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

SKILLS AND ABILITIES:
1. Time management skills
2. Teamwork skills
3. Verbal and non-verbal communication skills
4. Ability to research and keep updated on payer relations
5. Strong organizational, financial, and analytical skills

Additional Job Description:

Scheduled Weekly Hours:

Shift:

Exempt/Non-Exempt:

Company:

Cost Center:

Address:

Equal Opportunity Employer

West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.