Overview

Provide leadership to ensure value delivery to Infusion or Pharmacy Business Office (FHI-PBO) customers, including internal business units and external customers. Develop, implement, ensure, and evaluate FHI-PBO metrics/benchmarks to demonstrate achievement, monitor effectiveness and report results. Coordinate day-to-day workloads of department teams. Provide home infusion or specialty pharmacy consulting services to FPS clients including all business office functions. Build strong relationships with clients and assist clients with the formation and implementation of billing and financials systems.

Responsibilities Job Description

Billing and Insurance

• Review payments for accuracy, ensure collection according to contracts, understand and follow-up with insurance companies to leverage the revenue process.

• Utilize preferred collection procedures to obtain insurance payments and ensure compliance with Fairview payer contracts.

• Ensure accuracy of Fairview Pharmacy Services’ (FPS) secondary billing processes and related vendor data feeds into FPS systems as required.

• Advocate on behalf of FPS to ensure the most efficient processes regarding claim resolution.

• Evaluate denials and trends.

• Provide proactive and ongoing follow-up and problem solving with insurance companies and pharmacy sites to identify trends, communicate proactively, and ensure accuracy in the process.

• Understand the overall workflow to proactively solve problems, provide analysis and evaluate trends in the revenue cycle.

• Demonstrated analytical skills including ability to reconcile payer remittances

• Understanding of payer denials and impact on FPS revenue cycle

• Display initiative to resolve 835 remittance issues including but not limited to; unapplied cash, claim exceptions and partial pays.

• Evaluate contracts, analyze payments and proactively problem solve to optimize the payment cycle.

• Provide claims resolution to ensure accuracy in the process.

• Proactively communicate with pharmacy staff and insurance companies regarding resolution

• Analyze existing reimbursement arrangements/networks and reimbursement and operational issues with claims systems and their subsequent impact on financial results.

• Monitor and performing day-to -day functions in infusion or pharmacy business office focusing on the area of Government, Commercial/Non-contract or Patient.

• Provide exceptional customer service

• Assist staff with problem solving, difficult accounts, and general questions as necessary

• Assist in addressing patient and site inquiries as necessary

• Approval of adjustments to receivable accounts, including write offs within authorized level and adjustments to patient and third-party A/R accounts

• Monitor credit balances in patient A/R

• Coordinate payment reduction requests from outside parties

• General support to Director of the department as needed.

• Develop, implement, ensure and evaluate PBO metrics/benchmarks to demonstrate achievement, monitor effectiveness and report results.

• Ensure optimal revenue cycle performance through evaluation, analysis and problem solving.

• Use data for projections as part of contractual analysis.

• Complete detailed financial impact analysis of provider rate.

• Produce reports for payment variances, rejected, denied and reduced claims

• Review payment process for accuracy; provide necessary follow-up

• Communicate and resolve reimbursement issues to coordinate payer/provider relations between payers and FPS

• Identify and communicate trends to improve overall revenue cycle performance

• Provide analysis to stakeholders with explanations of reimbursement finding from assigned providers utilizing Excel and displaying initiative to assist in identifying potential compliance issues to FPS staff and make recommendations to Finance management for resolution.

• Constantly analyze operations, and attempt to improve processes in order to provide better customer service and improve the revenue cycle

• Understanding of financial statement effect of dispenses, edits, re-bills, payment posting/take-backs, claims adjustments, and write-offs in the dispensing system and adherence to policy to ensure accuracy of all above related transactions as they relate to FPS financial statements.

• Participate and collaborate with the Director of the department in the collection functions of the business office with Regional and Site Managers, on-site billing staff, patients and/or their representative, insurance carriers, outside collection agencies, Contracting and other Fairview Departments.

• Manage staff including hiring, orienting, coaching, evaluating and effectively managing performance to ensure staff possess the needed skills to deliver high quality service to customers

• Provide ongoing, continuous management oversight, as a coach who supports the growth and development of employees.

• Oversee assigned area to ensure appropriate distribution of workload and streamlined workflow.

• Recruit/interview/hire staff. Coordinate orientation of new staff and ensure ongoing education of current staff.

• Provide mentoring, leadership and direction to staff

• Maintain and monitor the productivity level of the staff to maximize efficiency, assure adequate staffing levels, and control costs; approve timecards.

• Complete timely performance reviews of staff according to policy.

• Provide industry expertise to FPS consulting clients. Duties include meeting with client’s executives or professionals to make suggestions and develop improvement plans based on their needs and maintaining a professional relationship with the clients over time.

• Provide home infusion or specialty pharmacy coaching and training to FPS clients

• Brainstorm strategies for growth, positive changes and improvements

• Dedicate time to FPS consulting clients

• Help clients perform an initial assessment, discuss goals and strategize methods for improvement

• Help solve client’s problems through helpful recommendations and practical suggestions

• Collect data for clients and the business through working with client’s staff

• Provide industry expertise to FPS’ venture partners. Duties include meeting with venture partner’s executives or professionals to provide insight and feedback on the venture partner’s proposed solutions and products.

• Develop a clear understanding of the product/service that is being developed with the venture partner and critically analyze to ensure the product/service will provide enhanced value to the revenue cycle workflows.

• Provide home infusion or specialty pharmacy revenue cycle insights to venture partner teams to assist with product/service improvements.

• Collaborate with venture partners on quality assurance testing for minimal viable products and provide recommendations on improvements that would enhance the efficiency, financial gain, and accuracy of the infusion or specialty pharmacy revenue cycle workflows/processes.

Organization Expectations, as applicable:

• Demonstrates ability to provide care or service adjusting approaches to reflect developmental level and cultural differences of population served

• Partners with patient care giver in care/decision making.

• Communicates in a respective manner.

• Ensures a safe, secure environment.

• Individualizes plan of care to meet patient needs.

• Modifies clinical interventions based on population served.

• Provides patient education based on as assessment of learning needs of patient/care giver.

• Fulfills all organizational requirements

• Completes all required learning relevant to the role

• Complies with and maintains knowledge of all relevant laws, regulation, policies, procedures and standards.

• Fosters a culture of improvement, efficiency and innovative thinking.

• Performs other duties as assigned

Qualifications

Minimum Education:

• Bachelor’s in business, healthcare or related field

Minimum Experience:

• Five years’ experience in healthcare, including reimbursement analysis, collection experience, training and or revenue cycle process. Previous supervisory experience.

Preferred Education

• Advanced degree - MBA, MHA

Preferred Experience:

• Two years supervisor or manager experience in customer service field. Five years pharmacy reimbursement analysis and collection experience including experience with Medicare, Medicaid and Commercial Payer experience. Pharmacy dispensing knowledge and/or experience preferred.

EEO Statement

EEO/AA Employer/Vet/Disabled: All qualified applicants will receive consideration without regard to any lawfully protected status