Pharmacy Business Coordinator - Home Infusion (JR24-40580) - West Virginia University Hospitals, Inc.
Morgantown, WV
About the Job
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Responsible for conducting payer discussions, in-house financial audits, payer performance compliance, prepayment claims audit, CMS CERT audits, CMS Fraud, Waste, & Abuse audits, and auditing 3rd party payer compliance. They must maintain knowledge of revenue cycle operations, third party reimbursement procedures & regulations, payer relations, claims adjudication, contractual claims processing, medical terminology, and an understanding of the 340B Drug Discount Program. Knowledge will include at minimum, all aspects of payer relations, claims adjudication, contractual claims processing and general reimbursement procedures. Provides customer support and resolves problems that may arise as a result of customer inquiries. Supports the work of the department by completing reports and performing clerical duties as needed. Responsible for performing pharmacy related functions in compliance with departmental policies and procedures that provide optimal pharmaceutical care.
Additionally, the Pharmacy Business Coordinator may be responsible for securing registration data based upon comprehensive data elements, financial education/counseling, insurance verification, provision of clinical information for pre-certification, authorization and third party claims management. Interviews patient and arranges alternate methods of payment. Ability to calculate patient co- payments and deductibles based upon benefits processing.
MINIMUM QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. Bachelor's Degree in Healthcare Administration or Business related field OR Certified by the Pharmacy Technician Certification Board.
EXPERIENCE:
1. Two (2) years of experience working in a pharmacy or healthcare setting.
PREFERRED QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. Completion of a 340B Certificate Program.
2. Bachelor's Degree in Healthcare Administration or Business related field AND Certified by the Pharmacy Technician Certification Board upon hire.
EXPERIENCE:
1. One (1) year of recent experience working in a specialty pharmacy.
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. Drafts various correspondence letters and sends to referral source when necessary.
2. Gathers and documents demographics, insurance information, needs assessment, and other data as needed.
3. Initiates refill/follow... For full info follow application link.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities.
Please view Equal Employment Opportunity Posters provided by OFCCP here.
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)
Responsible for conducting payer discussions, in-house financial audits, payer performance compliance, prepayment claims audit, CMS CERT audits, CMS Fraud, Waste, & Abuse audits, and auditing 3rd party payer compliance. They must maintain knowledge of revenue cycle operations, third party reimbursement procedures & regulations, payer relations, claims adjudication, contractual claims processing, medical terminology, and an understanding of the 340B Drug Discount Program. Knowledge will include at minimum, all aspects of payer relations, claims adjudication, contractual claims processing and general reimbursement procedures. Provides customer support and resolves problems that may arise as a result of customer inquiries. Supports the work of the department by completing reports and performing clerical duties as needed. Responsible for performing pharmacy related functions in compliance with departmental policies and procedures that provide optimal pharmaceutical care.
Additionally, the Pharmacy Business Coordinator may be responsible for securing registration data based upon comprehensive data elements, financial education/counseling, insurance verification, provision of clinical information for pre-certification, authorization and third party claims management. Interviews patient and arranges alternate methods of payment. Ability to calculate patient co- payments and deductibles based upon benefits processing.
MINIMUM QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. Bachelor's Degree in Healthcare Administration or Business related field OR Certified by the Pharmacy Technician Certification Board.
EXPERIENCE:
1. Two (2) years of experience working in a pharmacy or healthcare setting.
PREFERRED QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. Completion of a 340B Certificate Program.
2. Bachelor's Degree in Healthcare Administration or Business related field AND Certified by the Pharmacy Technician Certification Board upon hire.
EXPERIENCE:
1. One (1) year of recent experience working in a specialty pharmacy.
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. Drafts various correspondence letters and sends to referral source when necessary.
2. Gathers and documents demographics, insurance information, needs assessment, and other data as needed.
3. Initiates refill/follow... For full info follow application link.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities.
Please view Equal Employment Opportunity Posters provided by OFCCP here.
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)
Source : West Virginia University Hospitals, Inc.
