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.

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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 Pharmacy's computer system to comply with Medicare's charging rules charging. This requires strong knowledge, judgment, and teamwork skills. Directs Pharmacy programmers, and works collaboratively with programmers outside the Pharmacy, to accomplish changes.
* Maintain, modify, and ensure the integrity & security of the Pharmacy's billing, order entry, and patient information computer systems and related databases. Diagnose problems with these computer systems. Define and develop solutions to such problems. Direct other departmental computer programmers/analysts in implementing these needed changes. Also, often work collaboratively across departmental lines with numerous VUMC computer programmers & analysts to get VUMC computer systems to interface successfully with the Pharmacy's systems. Help to test and implement new computer systems.
* Serves as one of the Pharmacy's primary experts on these kinds of issues. Has primary responsibility for many aspects of the Pharmacy's computer systems and databases related to order entry, charging, and patient information. Shares responsibility on other aspects of these.
* Often identifies problems that cut across departmental lines due to the many other VUMC systems that interface with the Pharmacy's computer systems. Takes the lead in working collaboratively with other departments' computer programmers and analysts to develop, test, and implement solutions.
* Also, helps to test new VUMC billing and patient information systems to make sure they will work properly with the Pharmacy's computer system, and that proper patient billing results. Works with a wide range of VUMC staff to diagnose and resolve problems with such new or upgraded software.
* This person has to be able to understand very technical aspects of each computer system's software. But, they must also grasp the "big picture" of what the end result needs to be, and how the various computer systems should work together.
* Uses wide range of knowledge, as well as problem solving ability, to trouble-shoot problems across a tremendously complex array of different systems & interfaces.
* Uses strong communication skills to be able to work effectively with a very wide range of staff at VUMC, as well as computer vendor support staff from outside of VUMC.
* Train pharmacists and technicians and business operations staff members in the proper use of the Pharmacy's revenue cycle systems. Provide ongoing technical support to these users as needed. Supervise all Pharmacy staff's performance in areas that impact proper billing and collecting.
* Uses good communication skills to help train new staff in the functioning of the Pharmacy's system This includes both pharmacists and non-pharmacist staff members.
* Provides corrective feedback and additional training when needed to individuals in Pharmacy based on QA reviews. This may be either directly or indirectly through their supervisors.
* Discusses continuing patterns of errors with the appropriate manager for resolution.
* Works to catch and correct charge errors before they get billed to patients.
* Serves as a key resource for pharmacy revenue cycle issues. Contacted daily by other staff members for help in fixing problems or in handling complex situations.
* Monitor reimbursement of Pharmacy charges to help ensure proper cash flow to VUMC. Work collaboratively across departmental lines to diagnose and resolve reimbursement problems.
* Conducts research and analysis of payment received versus charges for selected high cost and/or high volume drugs to determine how well VUMC is being paid. This includes both one-time projects and ongoing monitoring.
* Such research may be based on this employee's own initiative, or in response to requests from senior departmental and VUMC leadership.
* Works with staff from outside the Pharmacy (especially Patient Accounting and Department of Finance staff) in conducting these reviews.
* Uses a strong knowledge of the very complex details of how charges post to a patient's account, how they are billed, how payment is received and posted to the account, etc. in conducting these reviews to arrive at accurate conclusions.
* Once this person identifies a pattern of lower than appropriate reimbursement, they conduct research with various VUMC staff regarding front-end processes to determine the impact of such processes on reimbursement and helps to decide which areas need to be followed up on to improve VUMC's cash flow and reports to the appropriate senior leadership.
* Works collaboratively with various VUMC staff to develop ways to improve reimbursement.
* Performs financial analysis as requested by both Pharmacy and VUMC senior leadership, particularly to assist in the budget preparation process.
* Use strong job knowledge and strong math skills to perform such analysis. Works to spot patterns in complex financial date and deduce the causes of such patterns.
* Performs within often short deadlines. Provides clear, complete, & accurate analysis that senior leadership can depend on when making decisions.
* Presents such analysis in meetings with senior departmental & other VUMC leaders. Uses detailed knowledge & strong communication skills to do so successfully

Our professional administrative functions include critical supporting roles in information technology and informatics, finance, administration, legal and community affairs, human resources, communications and marketing, development, facilities, and many more.

At our growing health system, we support each other and encourage excellence among all who are part of our workforce. High-achieving employees stay at Vanderbilt Health for professional growth, appreciation of benefits, and a sense of community and purpose.

Core Accountabilities:

* Organizational Impact: Directs activities to achieve operational plans with some near term effect on results of the department/area.* Problem Solving/ Complexity of work: Identifies issues, gathers facts to resolve technical and operational problems. * Breadth of Knowledge: Applies in-depth knowledge and skills of a professional/technical area and basic management knowledge to manage the work of the team.* Team Interaction: Leads a complex department with a focus on implementation. Typically executes on a short to medium term strategies.

Core Capabilities :

Supporting Colleagues: - Develops Self and Others: Invests time, energy, and enthusiasm in developing self/others to help improve performance e and gain knowledge in new areas. - Builds and Maintains Relationships: Maintains regular contact with key colleagues and stakeholders using formal and informal opportunities to expand and strengthen relationships. - Communicates Effectively: Recognizes group interactions and modifies one's own communication style to suit different situations and audiences .Delivering Excellent Services : - Serves Others with Compassion: Seeks to understand current and future needs of relevant stakeholders and customizes services to better address them. - Solves Complex Problems: Approaches problems from different angles; Identifies new possibilities to interpret opportunities and develop concrete solutions. - Offers Meaningful Advice and Support: Provides ongoing support and coaching in a constructive manner to increase employees' effectiveness. Ensuring High Quality - Performs Excellent Work: Engages regularly in formal and informal dialogue about quality; directly addresses quality issues promptly. - Ensures Continuous Improvement: Applies various learning experiences by looking beyond symptoms to uncover underlying causes of problems and identifies ways to resolve them. - Fulfills Safety and Regulatory Requirements: Understands all aspects of providing a safe environment and performs routine safety checks to prevent safety hazards from occurring. Managing Resources Effectively: - Demonstrates Accountability: Demonstrates a sense of ownership, focusing on and driving critical issues to closure.- Stewards Organizational Resources: Applies understanding of the departmental work to effectively manage resources for a department/area. - Makes Data Driven Decisions: Demonstrates strong understanding of the information or data to identify and elevate opportunities. Fostering Innovation: - Generates New Ideas: Proactively identifies new ideas/opportunities from multiple sources or methods to improve processes beyond conventional approaches. - Applies Technology: Demonstrates an enthusiasm for learning new technologies, tools, and procedures to address short-term challenges. - Adapts to Change: Views difficult situations and/or problems as opportunities for improvement; actively embraces change instead of emphasizing negative elements.

Position Qualifications:

Responsibilities:

Certifications:

LIC-Pharmacy Technician - Tennessee

Work Experience:

Relevant Work Experience

Experience Level:

4 years

Education:

Graduate of an approved discipline specific program

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 to the principles of equal opportunity and affirmative action. EOE/AA/Women/Minority/Vets/Disabled