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Pharmacy Revenue Cycle Specialist

Job Description

Job ID:
31714

Location:
450 Brookline Ave, Boston, MA 02215

Category:
Pharmacy

Employment Type:
Full time

Work Location:
Full Remote: 4-5 days remote/wk

Overview

The Pharmacy Revenue Cycle Specialist is responsible for analyzing medication charge capture processes to maximize revenue performance, enhance monitoring and data analysis tools to detect potential billing errors, and ensure billing compliance with all applicable regulatory guidelines.

The position is primarily remote but will require some on-site orientation.   Candidate must reside in a New England state. 

Located in Boston and the surrounding communities, Dana-Farber Cancer Institute brings together world renowned clinicians, innovative researchers and dedicated professionals, allies in the common mission of conquering cancer, HIV/AIDS and related diseases. Combining extremely talented people with the best technologies in a genuinely positive environment, we provide compassionate and comprehensive care to patients of all ages; we conduct research that advances treatment; we educate tomorrow's physician/researchers; we reach out to underserved members of our community; and we work with amazing partners, including other Harvard Medical School-affiliated hospitals.

Responsibilities

  • Analyze Pharmacy’s revenue cycle processes to ensure the complete, accurate, and timely charge capture of medications and other pharmacy services.
  • Review encounters within Pharmacy’s charge work queue to evaluate for billing and coding accuracy.
  • Analyze Pharmacy’s pre-billing edits and assist in updating edit criteria to further enhance charge capture integrity and reinforce billing compliance.
  • Assess industry trends and emerging regulatory guidance to inform leadership of potential revenue stream opportunities and identify emerging changes in reimbursement policies that impact pharmacy business.
  • Assist in maintaining compliance with single-use waste billing guidelines.
  • Implement and maintain payer coverage rules related to biosimilar medications.
  • Assist in identifying and reviewing medication HCPCS code and cost updates.
  • Support patient assistance program workflows in coordination with Finance.
  • Run and validate month end financial reports in coordination with Pharmacy Business Operations.
  • Perform charging and documentation audits to evaluate compliance with billing and coding standards and regulations.
  • Support third-party compliance audits, extract, and manipulate large datasets, summarize key findings, and perform data mining to identify trends.
  • Extract, summarize, and share periodic billing compliance reporting metrics to compliance leadership and institutional stakeholders as needed.
  • Assess compliance with applicable regulations pertaining to the security and accountability of controlled substances.
  • Assist in investigating instances of drug loss and potential diversion.

Qualifications

  • High school diploma or GED required.
  • 5 years of pharmacy technician or healthcare billing compliance experience required.
  • Board of pharmacy registration as a pharmacy technician preferred.

KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED:

  • Demonstrate critical thinking skills (ability to analyze information objectively and make a reasoned judgement); demonstrated success in developing and implementing appropriate responses to complex emergent/urgent issues, including ability to identify issues for appropriate and sensitive escalation.
  • Prioritizes and adapts to change; accepts additional responsibilities based on the changing needs of the work setting.
  • Proficiency with Microsoft Suite of Programs (i.e., Outlook, Excel, Word, Teams).
  • Strong organizational and time management skills, including the ability to work independently and prioritize multiple assignments with a strong focus on managing details.
  • Detail oriented with good written and verbal communication skills.
  • Works effectively as a member of a unit team, cross-functional teams and thrives in team-oriented environments.
  • Ability to work in a fast-paced complex and matrixed environment.

At Dana-Farber Cancer Institute, we work every day to create an innovative, caring, and inclusive environment where every patient, family, and staff member feels they belong.  As relentless as we are in our mission to reduce the burden of cancer for all, we are equally committed to diversifying our faculty and staff.  Cancer knows no boundaries and when it comes to hiring the most dedicated and diverse professionals, neither do we. If working in this kind of organization inspires you, we encourage you to apply.

Dana-Farber Cancer Institute is an equal opportunity employer and affirms the right of every qualified applicant to receive consideration for employment without regard to race, color, religion, sex, gender identity or expression, national origin, sexual orientation, genetic information, disability, age, ancestry, military service, protected veteran status, or other groups as protected by law.

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