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Pharmacy Revenue Analytics Program Lead - Silver Spring10100 Children's Hospital • Silver Spring, Maryland, United States
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Pharmacy Revenue Analytics Program Lead - Silver Spring

10100 Children's Hospital
  • US
    Silver Spring, Maryland, United States
  • US
    Silver Spring, Maryland, United States
Postuler Maintenant

À propos

Pharmacy Revenue Analytics Program Lead
Location: 1 Inventa Place, Silver Spring, MD 20910 Shift: Variable Pay Range: $82,222.40 - $137,051.20 About the Role
The Pharmacy Revenue Analytics Program Lead reports to the Pharmacy Business Manager and Vice President & Chief Pharmacy Officer. The role defines and carries out the data and process improvement strategy to maximize pharmacy revenue. Working with Informatics, the Lead ensures the availability and interpretation of reporting and analytics necessary for the Division to drive financial improvements. Responsibilities include financial modeling, impact analysis, revenue forecasting, drug utilization analysis, markup analysis, and ad hoc reporting. The Lead works directly with pharmacy staff and leadership to ensure the quality and efficiency of all elements of charge capture, oversees revenue improvement initiatives, actively develops, interprets, reviews, and shares data from all phases of the pharmacy revenue cycle process to identify opportunities for charge capture improvement and gross revenue optimization. The Lead works independently with departments and revenue leaders to resolve pharmacy revenue management issues, analyze key data metrics, review findings, and recommend improvements to revenue capture and reconciliation. The Program Lead serves as the key subject matter expert who monitors and improves pharmacy data and revenue processes for the Division. Qualifications
Minimum Education: Bachelor's Degree or Equivalent Experience (Required) Master's Degree or Equivalent Experience (Preferred) Minimum Work Experience: 6 years healthcare experience in pharmacy charge capture, revenue cycle, finance, decision support, or related business analytics (Required) 3 years experience with revenue cycle/financial information systems (Required) 2 years prior supervisory experience (Preferred) Required skills and knowledge: Demonstrated ability to conduct broad and detailed financial data analysis, identify and prioritize opportunities, and manage teams and processes to drive change. Proficient in Microsoft Suite (Excel, Word, PowerPoint, Access). Ability to work independently and in a team environment. Strong presentation skills for various audience levels. Solid understanding of information systems principles, familiarity with Cerner system is ideal. Strategic thinking connecting data flows to business outcomes. Demonstrated facilitation of team activities and leadership qualities, professional verbal and written communication skills. Functional Accountabilities
Revenue Optimization Program Administration
Develop policies, guidelines, and procedures for pharmaceutical coding, billing, pricing, charging, and denial management to maximize reimbursement and compliance. Perform quality reviews to ensure that pharmacy charge description master (PCDM) additions, inactivations, changes, and revisions are accurately completed in the hospital clinical and financial systems. Work with Pharmacy & Therapeutics Committees, Oncology Service Lines, and Managed Care to ensure formularies are aligned. Actively research and stay current with billing and revenue-related compliance and optimization topics to guide organization decisions. Collaborate with Finance, Revenue Integrity, Compliance, Decision Support, and other departments to standardize and optimize pharmacy charging workflows, revenue, business processes, billing, denial management, and collections. Lead pharmacy charging or revenue related projects and workflow changes, document risk areas, financial impact, and workflow procedures. Communicate findings to management and oversee implementation of approved recommendations. Develop process flows, education, and communications to improve revenue integrity and compliance. Collaborate with upper management to evaluate current and new program initiatives for effectiveness, feasibility, performance measurement, and cost; ensure compliance with organizational and departmental policies and regulatory standards. Participate and lead committees, work groups, process improvement efforts, and educational initiatives to improve pharmacy revenue integrity and the billing cycle. Act as the system expert on medication-related compliance billing and charging topics. Provide education to site and system stakeholders to drive optimal revenue capture. Work with sites, managed care, and the business office to decrease medication-related claim denials and outstanding claims. Serve as liaison between Finance, Revenue Integrity, Compliance, Decision Support, Pharmacy, and other departments to standardize and optimize charging workflows and processes. Collaborate with Pharmacy Leadership to determine patient access to high cost injectable therapies and reimbursement options, provide assistance on 340B operational reporting for outpatient departments. Research and stay current with important billing and revenue-related compliance and optimization topics to guide decisions. Utilize industry information such as HFMA, AAHAM, Children's National Hospital peer resources, State Hospital Association, CHA, Vizient to monitor national and regional trends, innovations, successes, and benchmarks related to pharmacy revenue cycle. Program Reporting, Analytics, & Information Resources Management
Responsible for overall Pharmacy Revenue Cycle Dashboard reporting on a weekly and monthly basis. Develop analytical tools to audit and analyze hospital pharmacy data elements to ensure accurate billing and maximal revenue capture. Analyze data on all Pharmacy Revenue KPIs. Monitor, track, and trend special scenarios impacting revenue such as oncology patients, temporary patients, medication waste, interdepartment chargebacks, etc. Participate in financial analyses of proposed changes to determine charge and revenue implications related to PCDM maintenance. Develop quality metrics and audit methodologies to drive accuracy and first-time quality for HCPCS/CPT codes, revenue codes, billable units, multipliers, modifiers, and indications. Provide strategic support of AR strategy related to reporting and focus areas for improvement. Identify revenue improvement opportunities through data analysis and process review. Ensure ad hoc report requests from other departments are handled timely and accurately. Provide recommendations to reporting teams for optimal pharmacy workload statistics and other pharmacy reports or dashboards. Acts as the super user of the Pharmacy Revenue Cycle and other reporting tools; provide key input on system upgrades or enhancements. Utilize multiple IT systems such as Business Objects, Avalead, and others to manage analysis, issue research and resolution, and process improvement implementation. Perform analysis and data mining of charge, payment, and denials using Excel, Access, and available reporting; oversee data analysis, trending and management reporting related to the Pharmacy Revenue Cycle. Actively support initiatives related to systems optimization and compliance. Benefits
Comprehensive health coverage including medical, prescription, infertility, and transgender health services Generous paid time off including vacation accrual from day one, sick leave, holidays, and a personal day Financial wellness support including a 401(k) plan and healthcare and dependent care spending accounts Employer‑paid life, AD&D, and long‑term disability coverage with optional supplemental plans Tuition assistance, fitness resources, employee assistance, commuter benefits, and more Salary Expectations
The disclosed salary range includes the minimum and maximum rates within which Children's National believes an individual's base pay rate will fall for this position. The exact pay rate will be based on a variety of factors in alignment with Children's National compensation philosophy, including market conditions, organizational needs, and the individual's combination of prior work experience, level of education, knowledge, skills, and other qualifications. Equal Employment Opportunity
Children's National Hospital is an equal opportunity employer that evaluates qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender, identity, or other characteristics protected by law. The Know Your Rights poster and the pay transparency Nondiscrimination poster are available. Children's National Hospital maintains a drug‑free workplace policy, prohibiting illegal use, possession or distribution of controlled substances, including recreational or medical marijuana.
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  • Silver Spring, Maryland, United States

Compétences linguistiques

  • English
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