General Summary:

Under the general supervision of the Vice President for Pharmacy services, is responsible for, but not limited to, all pharmacy cost and revenue related activities such as report preparation, department audits, reconciliation procedures, QA monitoring, denials management, revenue-based statistics, CDM (Charge Description Master) maintenance, training clinical staff on charge-capture processes and subsequent charge review post procedure.

Duties and Responsibilities:

The following are essential job accountabilities:

Supports cost and revenue impact decision making related to new drug/biosimilar product addition and removal from formulary. Provides assistance to all pharmacy revenue generating departments to ensure uniform application of the Charge Master in all areas, regulatory agency compliance and compliance with System policies and procedures. Coordinates departmental Charge Master reviews and recommends price increase changes as needed.  Provides education and assistance to the pharmacy director and managers regarding function of the Charge Master. Ensures appropriate compliance with Charge Master and revenue capture processes for new pharmacy services being considered by the facility. Performs department charge process and charge reconciliation audits to ensure compliance with hospital and department policy and procedures; creates and modifies policies and procedures relating to gross revenue and reconciliation processes. Oversees all patient charge audits. Monitors departmental usage of reports to ensure issues are being identified and addressed with continuous quality improvements in addition to providing education to departments on improving pharmacy revenue accuracy. Builds collaborative relationships with internal and external stakeholders to execute revenue cycle management goals and objectives. Coordinates charge capture audits with the appropriate teams to identify charge capture loss, identifies the gaps and process improvement opportunities, identifies and implements best practice resolutions, communicates changes, metrics and ongoing improvement initiatives. Works with all personnel involved in the pharmacy revenue cycle to optimize technology in the charge capture process. Supports timely resolution of issues, provides incident management and problem resolution.  Assists external departments in denial management.  Work with strategic sourcing and GPO for contract performance and financial impacts Create P&L for all medications and advises P&T on inpatient and outpatient formulary

The following are common expectations:

Assists in selecting staff, trains/orients personnel, evaluates performance, prepares work schedules and makes recommendations for personnel actions. Assists in departmental planning. Demonstrates a commitment to patient, visitor and staff by: complying with all applicable safety regulations; learning the impact of medical errors and methodology that will lead to reduction of errors; reporting actual and potential errors, as well as hazardous conditions; identifying opportunities to standardize processes and "error proof" systems that will lead to increased safety; and participating in safety education programs and root cause analyses as required. Maintains established policies and procedures, objectives, quality assessment, safety, environmental and infection control standards. Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise. Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.