Supervisor - Pharmacy Revenue Cycle

POSITION SUMMARY:

Under the general direction of the Director of Revenue Cycle Pharmacy. The Revenue Cycle Pharmacy Supervisor will perform functions to supervise the reimbursement functions of multiple retail, infusion and specialty pharmacy business units. This role will include focus on referral intake, authorizations, billing, and collections functions. This role can be complex due to the responsibility for ensuring that the financial systems are operational and effective in collecting payments from patients, insurance companies, and government programs.

Will cultivate an environment of outstanding customer service in all interactions with internal business partners, payers, and patients. Includes development of a highly effective team that can meet the critical challenges of timely, and successful reimbursement from payers. The Revenue Cycle Supervisor Pharmacy acts as a liaison between clinic operations leadership, third party billing vendor and other departments with Boston Medical Center.

Position: Supervisor - Pharmacy Revenue Cycle       

Department: Pharmacy Revenue Cycle

Schedule: Full Time

ESSENTIAL RESPONSIBILITIES / DUTIES:

• Supervise the day-to-day operations of Pharmacy Revenue Cycle staff, this includes but is not limited to: interviewing and hiring qualified staff, orienting new employees, coaching and mentoring staff on job requirements, policies and work procedures, developing training programs, counseling staff on performance/behaviors, and general planning and coordinating of the team’s activities.
• Maintain high-performance in reimbursement team metrics, including day’s sales outstanding, percent of open claims, percent of unapplied cash, and percent of bad debt.
• Support the pharmacy leadership team and organization by producing reports that share key information and provide guidance on fiscal and revenue cycle performance.
• Monitor daily operating activity of department; conduct huddles with staff to review department performance and goals and make necessary adjustments in work assignments.
• Provide leadership, direction and guidance; Set departmental goals and priorities and assign management oversight for the daily office operations.
• Develop and maintain operating procedures to support standardization and efficiency within the pharmacy fiscal team and pharmacy billing systems. Update as appropriate with changes in regulation, technology, or payer guidance.
• Monitor status of staff workload using reports that identify weekly activity performed, trends in activity and impact of unworked accounts.  Provide feedback to staff regarding the status of assignments and instruction in processes that will resolve balances and meet or exceed best of practice standards.
• Work collaboratively with departments, practices and third party billing vendor to drive organizational efficiencies and alignment and to ensure processes and systems are standardized and optimized for efficient and effective flow of patient accounts
• Participate in department sessions to explain billing and follow-up procedures and how the entry of information to various computer applications affects the pharmacy and hospital A/R. 
• Support the pharmacy leadership team and organization by producing reports that share key information and provide guidance on fiscal and revenue cycle performance.
• Responsibilities also include maintaining accurate systems for payment collection including cash, checks, ACH payments, payment cards, patient accounts and payroll deduction. This position interacts and collaborates routinely with the finance and treasury departments for posting pharmacy details to the GL, coordinating retail pharmacy financial assistance processes, and procedures for billing adjustments and write-offs. 
• Other duties as assigned.

Staffing and Development

• Oversees activities to ensure goals and objectives of the organization are met by specified target dates
• Creates and fosters a work environment that encourages productivity and work loyalty and employee satisfaction.
• Conducts performance appraisals for direct report staff and ensures all performance appraisals in department are completed timely.
• Maintains appropriate staffing levels by planning and working closely with recruiters in Human Resources and the Revenue Cycle Human Resources Business Partner
• Ensures proper employee orientation, supervision and productivity monitoring
• Administers coaching and disciplinary measures as needed
• Evaluates opportunities to automate work functions to reduce cost of doing business associated with labor costs.

Meets hospital-wide standards in the following areas:

• Conforms to hospital standards of performance and conduct, including those pertaining to patient rights, so that the best possible customer service and patient care may be provided.
• Utilizes hospital’s Values as the basis for decision-making and to facilitate the hospital mission.
• Follows established hospital infection control and safety procedures
• Develops competencies as related to position.
• Performs other tasks as needed.

Must adhere to all of BMC’s RESPECT behavioral standards.

(The above statements in this job description are intended to depict the general nature and level of work assigned to the employee(s) in this job.  The above is not intended to represent an exhaustive list of accountable duties and responsibilities required).

JOB REQUIREMENTS

EDUCATION:

• Bachelor’s Degree in Business / Healthcare related field preferred.

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

• Certified Pharmacy Technician (preferred)
• Certified Coder CPC or RIHT (preferred)

EXPERIENCE:

• Minimum of 10 years management or supervisory experience required. Specifically, experience in an academic medical center supervising billing, collection functions.  Demonstrated leadership experience in the medical field required.

KNOWLEDGE AND SKILLS:

Technical

• Demonstrated ability in Epic and Epic Cubes.
• Highly skilled experience and knowledge of Windows-based software required, including but not limited to Microsoft Outlook, Word, PowerPoint and Excel.
• Comprehensive understanding of patient billing policies, procedures and health insurance standards, as well as familiarity of supervisory/managerial techniques and principles, in order to control professional financial billing activities.
• Proficient skills to collect, organize and analyze data, produce actionable reports and recommend improvements and solutions.

Leadership

• Proven track record of success in improving revenue cycle performance and customer service.
• Ability to implement change in a positive, sensitive and forward-thinking manner
• Effective analytical ability to develop and analyze options, recommend solutions to and solve complex problems and issues.
• Shown critical thinking skills.
• Knowledge of coverage of various types of insurance and their allowable benefits; regulations governing alternate sources of payment; and other regulations governing alternate sources for funds. This includes all Medicare and Medicaid regulations related to claims processing.
• Knowledge of pharmacy and medical billing conventions including NCPDP D.0, HCFA 1500 forms, EDI 837 claims, ACH payments, 835 remits and Medicare crossover payments.
• Experienced in auditing, training and communicating revenue cycle regulations and concepts.
• Ability to be part of a cross-departmental and cross-functional team, and participate in the organization and execution of projects.
• Knowledge of medical terminology and abbreviations. Able to read the medical and pharmacy records to find required claims information and appropriate payer for services provided.
• Positive attitude and ability to promote effective teamwork

Management

• Demonstrated ability to create an inspiring team environment with an open communication culture
• Demonstrated ability to motivate staff to perform at the highest possible level by listening to team members’ feedback and resolve any issues or conflicts
• Demonstrated ability to set appropriate priorities for self and staff, and to delegate appropriately.
• Ability to manage effectively across multiple tasks and projects under time and resource constraints
• Ability to carefully monitor processes and organize and maintain documentation.
• Demonstrated the ability to recognize high performance and reward accomplishments
• Demonstrated the ability to communicating the strategy and guiding the team towards targets

Compensation Range:

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensures as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, BMCHS offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), discretionary annual bonuses and merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family well-being. 

NOTE: This range is based on Boston-area data, and is subject to modification based on geographic location.

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