Pharmacy Reimbursement Specialist - Oncology
Pharmacy Reimbursement Specialist - Oncology
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Job Description
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 ofindividuals 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 is committed to an environment where everyone has the chance to thrive and where your uniquenessis 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. Vanderbilts mission is to advance health and wellness through preeminent programs in patient care education and research.
Organization:
High Cost Oncology Drug AuthorizationsJob Summary:
Evaluates reimbursement of medications provided to inpatients clinic patients and patients receiving prescriptions through the outpatient pharmacy network. Works with multidisciplinary groups to develop proper procedures and programs to maximize reimbursement. Facilitates process and system improvements to reduce the likelihood of occurrence of loss of reimbursement relating to pharmaceuticals..
Key Responsibilities
- Clarify and trend pharmaceutical denials and underpayments of the highest cost drugs and other drugs.
- Utilize data from finance and pharmacy systems to determine reimbursement rates for pharmaceuticals for various patient care settings.
- Evaluate actual reimbursement compared to defined contractual reimbursement rates for specific drugs/procedures.
- Provide trending on reimbursement and information on areas for focus to maximize reimbursement.
- Maintain data in appropriate database to facilitate evaluation and presentation of data.
- Evaluate data enabling the identification of trends by multiple variables.
- Work with patient accounting finance contracts and pharmacy to develop strategy for improved reimbursement.
- Utilizing data collected define areas for focus to maximize reimbursement and present plan to above departments.
- Maintain list of potential opportunities for reimbursement and contracting based on proactive review of data.
- Work collaboratively to develop programs and procedures to maximize reimbursement of pharmaceuticals.
- Facilitate process and system improvements to reduce the likelihood of occurrence of loss of reimbursement relating to pharmaceuticals.
- Work with pharmacy staff and finance to evaluate reimbursement of new drugs and propose necessary procedures to maximize reimbursement.
- Document enhanced reimbursement from developed programs and trend success of programs.
- Utilize databases maintained to provide documentation to support the effectiveness of the reimbursement program. Assist with regulatory compliance related to safe medication use with program operational regulatory bodies (JCAHO ASHP state and federal regulations Leapfrog etc.) and institutional policies and procedures.
- Provide written monthly update on activities and financial impact of program to enhance reimbursement.
- Assist billing manager and document regulatory compliance related to billing of pharmaceuticals and work to correct any variances.
- Work with Patient Assistance Programs (PAP) to include identifying new opportunities document receipt of funds and provide proper adjustment of patient accounting accounts.
- Collaborate with pharmacy finance contracts and patient accounting to identify ongoing opportunities to expand the PAP to reduce drug cost.
- Document savings from the PAP and provide a monthly report trending the savings from the program.
- Provide recommendations to pharmacy administration for input into hospital contracting for enhanced reimbursement.
- Maintain proper resources and contacts to understand the contractual reimbursement of pharmaceuticals.
- Maintain documentation on any issues with contractual reimbursement including the financial impact for review by pharmacy finance and contracting.
- Contribute to the continuing education of pharmacy on the reimbursement of pharmaceuticals and the contractual trends for reimbursement.
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: Performs clearly defines tasks and methods described in detail to achieve standardized solutions that impact own performance with regular guidance. * Problem Solving/ Complexity of work: Follows a well established process to solve routine problems where solutions are clearly prescribed. * Breadth of Knowledge: Has basic job knowledge of systems and procedures that are common to own job. * Team Interaction: Individually contributes to the team.Core Capabilities :
Delivering Excellent Services : Serves Others with Compassion: Invests time to understand the problems needs of others and how to provide excellent service. Solves Complex Problems: Seeks to understand issues solves routine problems and raises proper concerns in a timely manner. Offers Meaningful Advice and Support: Listens carefully to understand the issues and provides accurate information and support. Ensuring High Quality : Performs Excellent Work: Checks work quality before delivery and asks relevant questions to meet quality standards. Ensures Continuous Improvement: Shows eagerness to learn new knowledge technologies tools or systems and displays willingness to go above and beyond. Fulfills Safety and Regulatory Requirements: Demonstrates basic knowledge of conditions that affect safety and reports unsafe conditions to the appropriate person or department. Managing Resources Effectively: Demonstrates Accountability: Takes responsibility for completing assigned activities and thinks beyond standard approaches to provide high-quality work/service. Stewards Organizational Resources: Displays understanding of how personal actions will impact departmental Data Driven Decisions: Uses accurate information and good decision making to consistently achieve results on time and without error. Fostering Innovation :Generates New Ideas: Willingly proposes/accepts ideas or initiatives that will impact day-to-day operations by offering suggestions to enhance them. - Applies Technology: Absorbs new technology quickly; understands when to utilize the appropriate tools and procedures to ensure proper course of action.- Adapts to Change: Embraces changes by keeping an open mind to changing plans and incorporates change instructions into own area of work.Position Qualifications:
Responsibilities:
Certifications:
Work Experience:
Relevant Work ExperienceExperience Level:
1 yearEducation:
Graduate of an approved discipline specific programVanderbilt Health is committed tofosteringan environment where everyone has the chance to thrive and is committed to the principles of equal opportunity. EOE/Vets/Disabled.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
