Stanford Health Care Tri-Valley · 2 months ago
Clinical Pharmacist - Pharmacy Billing Specialist - Finance Business Ops
300P Hospital - C Phase One 300/400 - PALO ALTO
Full-time
Hybrid
Senior Level
$74.73/hr - $99.04/hr
5+ years expStanford Health Care Tri-Valley is a leading healthcare provider, and they are seeking a Clinical Pharmacist - Pharmacy Billing Specialist. The role involves supporting accurate and compliant billing for pharmacy services, ensuring consistency in charge capture, claims submission, and reimbursement, while also maintaining compliance with billing and pricing requirements.
Health CareHospitalNon Profit
Responsibilities
Designs, performs, and revises daily, weekly and monthly compliance verification of pricing and charges
Reviews and analyzes pharmacy billing data, including but not limited to charges and claims, to identify discrepancies, trends, and compliance gaps
Participates in/leads identified process improvement opportunities by providing data-driven insights and supporting/leading implementation of corrective actions as appropriate
Develops and contributes key performance indicator (KPI) data to the Pharmacy Billing Dashboard. Assist in maintaining dashboard
Collaborates with pharmacy and SHC revenue cycle teams to resolve billing issues and strengthen compliance with payer requirements
Assists with reimbursement optimization and denial prevention through timely issue identification and follow-up
Supports regulatory audits and other compliance requirements
Acts as the subject matter expert for all pharmacy billing programs
Responds to inquiries related to billing compliance issues. Researches applicable regulations/standards and provides appropriate guidance. Develops repository of inquiries and responses for future reference
Works collaboratively with other pharmacy business operations team members to assist with other duties as needed
Research activities (e.g. abstracts, posters, publications) are encouraged
Attends Pharmacy Management meetings to communicate issues with billings, charges, and claims
Leads various billing steering committees and other large group meetings as it related to pharmacy billing
Communicates and educates Clinic Administration, Clinic Managers and clinic staff on pharmacy-related issues such as regulatory changes/compliance, FDA drug recalls, drug information, special programs, sample medications, investigational studies, and other related medications
Coordinates with pharmacist and pharmacy technicians to develop and maintain standard work and operating procedures
Qualification
Required
PharmD Degree from an accredited college/university required
Five (5) years of progressively responsible and directly related work experience required
Implementation of a large-scale initiative that requires cross-functional coordination
Knowledge of healthcare regulations and policies affecting pharmacy billing, reimbursement, and financial compliance at both federal and state levels
Knowledge of other relevant regulatory guidelines (e.g., CMS, 340B, FDA)
Knowledge of theories, principles, practices and techniques of personnel management, including selecting, training, directing, evaluating, and supervising employees
Knowledge of and demonstrated proficiency in the use of the Microsoft Suite of software applications (Word, Excel, PowerPoint, Visio, Access, Project and Outlook)
Knowledge of financial operations and billing
Knowledge of project management process and systems
Knowledge of healthcare regulatory climate
Ability to mediate and resolve complex problems and issues
Ability to develop financial budgets and manage expenses
Ability to develop long-range business plans and strategies
Ability to develop and maintain productive and cooperative work relationships at all levels both within and outside the organization
Ability to communicate effectively at all organization levels and in situations requiring instructing, persuading, negotiating, conflict resolution, consulting and advising as well as prepare clear, comprehensive written and oral reports and materials
Ability to effectively manage and promote staff development
Ability to articulate strategic planning
Ability to lead process excellence team to effectively improve operational efficiencies
Ability to manage financial performance process including accuracy of submission
Demonstrated skills in analytical assessment, oral and written communication
Strong communication skills and ability to promote and maintain interpersonal relationships
CA-RPH (Register Pharmacist) required
Company
Stanford Health Care Tri-Valley
STANFORD HEALTH CARE TRI-VALLEY Stanford Health Care Tri-Valley (formerly ValleyCare) provides high-quality care rooted in science and compassion to support the health and well-being of its community in the East Bay and beyond.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Reena Jadhav
Board Member, Chair Comp & Workforce
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