Revenue Coordinator

Job Description:

The Pharmacy Revenue Coordinator acts as the 340B subject matter expert and provides oversight to all 340B Program Covered Entities, ensuring that the program is maximally and that related records are complete, accurate, auditable, and that primary objectives as defined are met. Responsible for day-to-day compliant medication procurement, billing, and inventory management to ensure compliance standards are being upheld and that cost savings returns are being realized. Assists with implementation of and adherence to 340B related policies and procedures. Oversees 340B internal audit program, and serves as the 340B analyst and assess data trends and reports as identified by the organization. Serves as primary point of contact for 340B compliance and audits, and coordinates JMH’s 340B Executive Oversight Committee. Analyzes contracts to maximize cost savings and/or identify areas that could be standardized to take advantage of potential cost savings. Reviews and investigates all aspects of the pharmacy revenue cycle to maximize charge capture and ensure appropriate reimbursement for services. Works collaboratively with other departments to ensure appropriate pricing and reimbursement of Pharmacy Services. Develops and produces routine reports to ensure close monitoring of revenue cycle. Prepare management reports that provide Pharmacy leadership with timely and relevant information on all aspects of revenue, compliance and audit issues.

Education:

• Bachelor of Science or Bachelor of Arts degree in business or health-related field – Required

• Master’s degree in business administration, healthcare administration, or other relevant subject area - Preferred

Experience:

• Must demonstrate three to five years of experience performing in a 340B hospital oversight role with responsibility for policies, audits, data analysis, and compliance.

• Must possess good organizational, problem-solving, and analytical skills

• Must demonstrate effective oral and written communication skills

• Experience in managing 340B purchases in a mixed-use setting with a third-party administrator

• Experience with 340B purchasing

Additional Experience:

• Must have advanced-level Microsoft Excel reporting and analysis skills.  Expert-level preferred.

• Must have experience overseeing a third-party administrator (TPA) integrated with an electronic health record (e.g. Epic)

• Experience overseeing a 340B contract pharmacy program (preferred)

• Experience with chargemaster maintenance and updates (preferred)

• Experience with pharmacy revenue integrity program oversight (preferred)

Certifications/Licensures:

• CPhT Pharmacy Technician - PTCB Pharmacy Technician Certification Board - Preferred

• Pharmacy Tech - California Board of Pharmacy - Preferred

• Apexus Advanced 340B Operations Certificate - Apexus – Required

Essential Job Functions:

Policy and Procedure Development/Training/Education Support

• Ensures that policies and procedures are developed, implemented, and maintained according to organizational, regional, national, state, and federal requirements and guidelines and are approved.

• Tracks organizational 340B training, policy compliance, and reports findings.

• Provides ongoing training, education, and communication required for the 340B Program at the organization.

• Regularly communicates with all staff involved with the 340B Program to be sure that processes remain efficient and to address any problems or suggestions for improvement.

Rules/Guidance Surveillance

• Monitors and assesses 340B guidance, industry publications and/or rule changes, including, but not limited to, HRSA/OPA rules and Medicaid changes. Ensures that the institution has the latest information regarding interpretations, rulings, suggestions, and advanced ideas for improving participation.

• Effectively and continually maintains open lines of communication with all staff and management involved with the 340B program. Provides timely and accurate communication, both written and verbal as appropriate, regarding changes and continuous quality improvement activities, including goals and objectives of the 340B program. Reports any deficiencies identified during auditing and review for appropriate resolution.

• Ensures that the 340B pharmacy program is continuously compliant with 340B federal regulations and updates policies and procedures.

Registration/Recertification

• Responsible for ensuring that the HRSA 340B OPAIS is accurate for all organization entities and ensuring that annual HRSA recertification is completed per established timelines, including any quarterly updates.

• Supports primary contact and authorized official to ensure proper registration and recertification are followed.

Self-Audits

• Develops, executes, and documents comprehensive self-audits of the 340B process. Conducts regular audits of all 340B-eligible locations to verify adherence with the 340B Program guidelines and policies, including contract pharmacy locations.

• Coordinates and ensures remediation of any audit finding..

• Responsible for managing and troubleshooting pharmacy billing issues and ensuring that adequate systems checks are reviewed to prevent future billing issues.

• Monitors utilization records and 340B purchasing accounts to ensure that software or tools are working properly and accurately, performing audits or compliance assessments internally as needed; coordinates external compliance assessments with outside firms, when appropriate, to validate internal processes.

• Evaluates patient eligibility for qualified and non-qualified patients in hospital-based mixed-use areas and clinics by reviewing patient medical records, insurance plans, and hospital status.

• Monitors 340B compliance within workflow processes.

• Responsible for the day-to-day management, compliance review, and operations of clinic-administered medications in eligible locations, mixed-use areas managed by split-billing software, outpatient prescriptions fulfilled by an owned pharmacy, and outpatient prescriptions fulfilled by a contract 340B pharmacy.

• Evaluates covered entity compliance at the contract pharmacy, covered entity, and wholesaler levels, including 340B purchasing.

• Performs regular independent compliance audits and reports findings to the 340B Executive Committee.

External Audits

• Serves as the point person and coordinator for all audits. Coordinates all requests and responses.

• Maintains a current state of “audit readiness.”

• Works with medical auditors on third-party payer audits to ensure coordination of efforts and maximum collection.

 340B Contract Management

• Manages relationships, billing services, and compliance with contracted 340B pharmacies.

Program Enhancement/Optimization

• Assesses opportunities for cost savings and business improvements with the 340B program.

• Develops action plans to close identified gaps in collaboration with organizational leadership.

• Provides oversight for the implementation of process improvement initiatives and creates an environment that places an emphasis on continuous monitoring and improvement.

340B Reporting

• Routinely prepares and monitors regular reports on 340B participation that clearly document utilization, savings, compliance, potential areas of concern, and exceptions or discrepancies, to be communicated to pharmacy leadership and the 340B oversight committee.

• Develops routine reports that are a by-product of the inventory process and software, allowing for concise information to be communicated to the leadership responsible for 340B inventory management.

• Constructs appropriate financial metrics to track program value and assess areas of opportunity.

• Reviews and refines 340B cost savings reports detailing purchasing and replacement practices, as well as dispensing patterns.

• Coordinates monthly financial reporting and analysis, including, but not limited to, metric reporting, scorecards, and variance analysis and reporting.

• Ensures appropriate documentation and audit trail across areas of responsibility.

Purchasing/Inventory Oversight

• Monitors purchasing records for each 340B participant; clearly documents utilization, savings, problem areas, and exceptions or discrepancies.

Relays results to pharmacy leadership and administration.

• Monitors for 340B pricing exclusions or shortages and establishes appropriate records to track exceptions.

• Participates with the Prime Vendor and routinely reviews 340B OPAIS pricing reports, identifying opportunities for formulary enhancement or wholesaler credits

• Manages and tracks 340B drug inventory, including proper replenishment.

• Ensures compliance with regulations related to 340B purchasing, including preventing GPO pricing for applicable accounts.

• May be required to work on inventory management of the 340B Program and offer input as to the application’s overall functionality and opportunities for improving compliance and or efficiency.

• Routinely monitors utilization records and 340B purchasing accounts to ensure that software or tools are working properly.

• Oversees 340B regulatory aspects of the inventory purchasing process for outpatient, inpatient, and mixed-use areas.

Split-Billing or Third-Party Administrator Software Maintenance

• Establishes a routine approach to updating the CDM/crosswalk for new products and product changes to ensure both the accuracy of the utilization report and the efficiency and accuracy of the charge process.

• Maintains 340B split-billing software integrity and reviews applicable reports to identify areas for improvement.

• Is responsible for maintenance and testing of tracking software.

• Integrates information from the pharmacy chargemaster system into the 340B split-billing computer system and incorporates that information into auditable and compliant processes.

• Works with outpatient pharmacy management and pharmacy informatics teams to ensure that the organization’s clinical information system is coordinated and integrated into the work with the 340B Program. This shall include the electronic interfaces between the EMR and the virtual accumulator and any interfaces between the organization and contract pharmacy providers and/or administrators.

• Ensures split-billing software integrity and reviews applicable reports for areas of improvement.

• Periodically performs audits or compliance assessments in specific areas and specific products to ensure that the CDM is accurate, charges are coming across accurately, and the utilization numbers are translating accurately into report for 340B reorders.

• Oversees split-billing software maintenance and maximizes compliance.

Revenue Functions

• Provides professional leadership as the manager for revenue cycle and billing compliance programs within Pharmacy Services.

• Maintains responsibility for pharmacy support of CDM maintenance.

• Ensures routine review and reporting related to revenue cycle management.

• Reviews, analyzes and implements process improvements in operational areas related to billing compliance and payer contracts.

• Ensures optimization of revenue capture.

• Works with Finance departments to ensure appropriate pricing and reimbursement of Pharmacy Services.

• Maintains, reviews, and updates pharmacy-related charge master items.  

• Establishes and monitors policies and procedures related to cash management and billing compliance. Ensure the effective implementation of adopted policies and procedures

• Participate in the financial analyses of any proposed changes to determine charge and revenue implications related to the pharmacy charge description master maintenance.

• Develop analytical tools to audit and analyze hospital pharmacy data elements to ensure accurate billing and maximal revenue capture.

• Actively research and stay current with important billing and revenue related compliance and optimization topics to guide appropriate organizational decisions

• Maintains, reviews, and updates pharmacy-related charge master items.  

• Establishes and monitors policies and procedures related to cash management and billing compliance. Ensure the effective implementation of adopted policies and procedures

• Participate in the financial analyses of any proposed changes to determine charge and revenue implications related to the pharmacy charge description master maintenance.

• Develop analytical tools to audit and analyze hospital pharmacy data elements to ensure accurate billing and maximal revenue capture.

• Actively research and stay current with important billing and revenue related compliance and optimization topics to guide appropriate organizational decisions

• Pharmacy Tech - California Board of Pharmacy - Preferred

• Apexus Advanced 340B Operations Certificate - Apexus – Required

This is an ON SITE ROLE with remote work up to 2 days per week.

Work Shift:

08.0 - 08:00 - 16:30 No Waive (United States of America)

Pay Range:

$46.10 - $69.13Hourly

Scheduled Weekly Hours:

40