Pharmacy Pricing and Compliance Specialist - Pharmacy (Full-Time, 8-Hour Day Shifts)
Pharmacy Pricing and Compliance Specialist - Pharmacy (Full-Time, 8-Hour Day Shifts)
Posted on :
16-05-2025
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1 Vacancy
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Job Description
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Day 08 Hour (United States of America)This is a Stanford Health Care job.
A Brief Overview
The Pharmacy Pricing & Compliance Specialist manages and maintains the accuracy compliance and optimization of the Pharmaceutical Charge Description Master (CDM) and related processes within SHC. This role supports Pharmacy Revenue Cycle and Business Operations through regular data analysis ensuring medication charges align with the current formulary pricing policies regulations and payer requirements. The specialist ensures pharmaceuticals are accurately recorded and priced based on approved cost bases and markups and collaborates with pharmacy revenue cycle finance compliance and SHC TDS to maintain billing integrity and support financial sustainability.
Locations
Stanford Health Care
What you will do
- 1. Pharmaceutical Chargemaster Maintenance & ComplianceOversee and maintain the pharmaceutical chargemaster ensuring that all pharmaceutical products are accurately priced and that all new pharmaceutical products and/or new formulary items are added to the chargemaster in timely manner ensuring correct codes (e.g. HCPCS NDC) billing units prices and timely updates and management of seasonal flu vaccines in the Charge Master to reflect changes in pricing and linking of correct procedure and charge detailed and regular audit for timely updates that reflect current codes costs pricing and various coding pricing markup databases and records for a strong understanding of Pharmaceutical Chargemaster revenue cycle applications operational workflows and regulatory policies to ensure compliance and to assist in analytic evaluations.
- 2. Coding Charge Capture & AuditingPerform coding ensuring accuracy and timeliness utilizing a software (e.g. Vitalware) for cross referencing HCPCS/NDC and assigning corresponding codes in EHR (e.g. Epic).Perform detailed and regular charge audits for missed system error or highcost pharmaceuticals and ensure correct charges are review and enter charges for CART therapies in timely regular root cause analysis of incorrect codes prices and markups for correction mitigation and prevention.
- 3. Financial Analysis & ReportingExamine historical and projected financial data to provide stakeholders with valuable information upon which to make operational summary findings of analysis for Pharmaceutical Pricing Oversight prepare and coordinate distribution of various financial reports for internal Revenue Cycle use and as required for external key performance indicators for assigned areas and explores reasons for performance fluctuation and and manipulate large data sets.
- 4. Collaboration & Relationship ManagementCultivate internal and external relationships to assist in understanding department regularly with Revenue Cycle team Pharmacy TDS on improvement opportunities identified through data analysis.
- 5. Strategic Initiatives & Other DutiesEngage in benchmarking activities to assess performance against industry standards and implement best analytics for and support special projects as other assignments based on the department may include Stanford TriValley pharmaceuticals and other areas such as Stanford radiopharmaceuticals.
Education Qualifications
- Doctor of Pharmacy (PharmD) or equivalent required.
Experience Qualifications
- Three (3) years of progressively responsible and directly related work experience in pharmaceutical billing coding 340B or chargemaster management preferably in a healthcare or hospital setting.
- Experience in pharmacy operations revenue cycle informatics or compliance.
- 12 years of statistical analysis experience preferred.
Required Knowledge Skills and Abilities
- Ability to analyze and develop solutions to complex problems.
- Ability to apply judgment and make informed decisions.
- Ability to manage organize prioritize multitask and adapt to changing priorities.
- Ability to communicate complex concepts in simple form to nonfinance users to understand the appropriate use and limits of information provided.
- Ability to communicate effectively in written and verbal formats including summarizing data presenting results.
- Ability to work independently and as part of a team.
- Strong attention to details.
- Ability to establish and maintain effective working relationships.
- Knowledge of hospital and physician revenue cycle methodology.
- Knowledge of hospital information systems including Epic.
- Knowledge of business analytical practices and methodologies.
- Knowledge of Microsoft Office software including strong knowledge of Excel.
Licenses and Certifications
- RPH Registered Pharmacist required
- CPC preferred
- CCS Certified Coding Specialist preferred
These principles apply to ALL employees:
SHC Commitment to Providing an Exceptional Patient & Family Experience
Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute CICARE standards for all of patients families and towards each other. CICARE is the foundation of Stanfords patientexperience and represents a framework for patientcentered interactions. Simply put we do what it takes to enable and empower patients and families to focus on health healing and recovery.
You will do this by executing against our three experience pillars from the patient and familys perspective:
- Know Me: Anticipate my needs and status to deliver effective care
- Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health
- Coordinate for Me: Own the complexity of my care through coordination
Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and nondiscrimination inall ofits policies and practices including the area of employment. Accordingly SHC does not discriminate against any person on the basis of race color sex sexual orientation or gender identity and/or expression religion age national or ethnic origin political beliefs marital status medical condition genetic information veteran status or disability or the perception of any of the above. People of all genders members of all racial and ethnic groups people with disabilities and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.
Base Pay Scale: Generally starting at $76.90 $101.91 per hourThe salary of the finalist selected for this role will be set based on a variety of factors including but not limited to internal equity experience education specialty and training. This pay scale is not a promise of a particular wage.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
Key Skills
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