Pharmacy Business Coordinator - Home Infusion (Billing and Revenue Cycle)

Operations Support Centermid

OtherCoordinator

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Quick Summary

Key Responsibilities

The statements described here are intended to describe the general nature of work being performed by people assigned to this position.

Requirements Summary

EDUCATION, EXPERIENCE, CERTIFICATION, AND/OR LICENSURE: 1. Bachelor’s Degree in healthcare administration, business, finance,

Technical Tools

OtherCoordinator

About the Role

~1 min read

This position is 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.

Requirements

~1 min read

1. Bachelor’s Degree in healthcare administration, business, finance, or related field AND one (1) year of business OR healthcare-related experience OR High School Diploma or Equivalent AND Nationally Certified Pharmacy Technician (PTCB or EXPT) upon hire AND two (2) years of healthcare-related experience OR Associate’s Degree AND Nationally Certified Pharmacy Technician (PTCB or EXPT) upon hire AND one (1) year of healthcare-related experience

1. PTCB Advanced Pharmacy Technician Certificate.

1. Three (3) years working in a specialty pharmacy.

Responsibilities

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1. Must be able to use computers and software applications.

2. Knowledge of drugs, drugs dosing, side effects, indications, contraindications and proper administration preferred.

3. Knowledge of rules, policies and regulations related to the disbursal of pharmaceutical drugs preferred.

4. Knowledge of clinical procedures or operations.

5. Must be able to work with multiple demands.

6. Must be able to work accurately, efficiently, and safely in a fast-paced environment.

7. Must be polite and respectful when communicating with staff, physicians, patients and families. Must approach interpersonal relations in a positive manner.

8. Must demonstrate flexibility to meet the needs of department or hospital in regard to changes in work volume, planned change, scheduling changes and emergency call-backs (i.e. weather or disaster).

9. Must be able to communicate effectively verbally and in writing and place high emphasis on customer service.

United States of America (Non-Exempt)

255 WVUH Home Infusion

West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.