Facility: Copley Drive

City San Diego

Department

Job Status

Regular

Shift

Day

FTE

1

Shift Start Time

Shift End Time

H.S. Diploma or Equivalent; Bachelor's Degree

Hours :

Shift Start Time:

8 AM

Shift End Time:

5 PM

AWS Hours Requirement:

8/40 - 8 Hour Shift

Additional Shift Information:

Weekend Requirements:

As Needed

On-Call Required:

No

Hourly Pay Range (Minimum - Midpoint - Maximum):

$23.750 - $29.477 - $35.204

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position.  The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.

What You Will Do

This position is responsible for operations and outcomes associated with pharmacy billing and collections. This role is responsible for the development, maintenance, and management of efficient work procedures and ongoing process improvement to ensure maximum reimbursement. Independently creating and implementing programs to collect payment from payors to compliantly maximize Sharp cash flow and revenue, while minimizing write offs and Days Sales Outstanding (DSO) is essential for this position.

Required Qualifications

• H.S. Diploma or Equivalent

• 5 Years retail pharmacy and managed care experience.

• Experience creating meeting materials with data, communicating trends, and presentation.

Preferred Qualifications

• Bachelor's Degree

Essential Functions

• Internal and External CommunicationsEstablishes and maintains relationships with PBM’s, government payers, Medi-cal, and managed care representatives, as applicable.Work as a liaison between Sharp, pharmacy payer sources, and patients to ensure client issues are resolved in a timely manner with minimal impact to accounts receivable.Works cooperatively with others and organizes daily workflow to optimize output.Provides service to customers to meet or exceed their needs and expectations.Communicating with customers (e.g., patients, caregivers, family members, physicians, nurses, pharmacists, and others) to obtain and communicate accurate information, resolve problems, and meet customer needs.Utilizing telephone and written communication skills and etiquette to obtain and provide information when needed.

• Daily OperationsRegularly monitors open balances and DSO to communicate this information to management and leadership – and identify opportunities for increased collections, as appropriate.Review and reconcile aging minimum weekly for collection opportunities.Takes action with payors to obtain payment for unpaid and underpaid claims.Monitors write-off trends, DSO, credit reviews, payment arrangements, and collection balances.Facilitates accounts receivable reduction to ensure DSO goals.Investigate discrepancies in the medication histories and other problems and following up with pharmacists to facilitate resolution of the problems.Collaborate with SRS PB team to manage WAM WQ indicating missing payments through SRS Pharmacy.Develops department goals and communicates these measures to management and leadership for monitoring.Reviews and recommends standardized procedures to improve departmental efficiencies.Document, record, track, and respond to all audit requests and ensure information is translated and accounted for in the accounts reconciliation system.Works independently and takes initiative to assess and meet workload demands, and ensure nothing falls through the cracks relative to medication delivery and PBM insurance billing.

• Policies and ProceduresThis position adheres to the standards of the Pharmacy Department to promote a cooperative work environment by utilizing excellent communication skills, interpersonal relationships, and team building.Responsible for following Sharp policies and procedures.Stays informed about changes in policies and procedures.Responsible for keeping up to date with insurance company regulations and requirements.

Knowledge, Skills, and Abilities

• Excellent customer service skills and communication skills demonstrated ability to manage time effectively, and good attention to detail.

• Knowledge of billing and coding requirements for Medicare, Medi-Cal, commercial and managed care payer sources.

• Well-developed communication skills.

• Proficient in accounts receivable language, verbiage, and financial methods, practices, and processes.

• Analytical skills and ability to work within strict deadlines. Ability to recognize, accurately research and resolve various errors that may occur.

• Ability to perform the essential functions of the job as outlined above.

• Ability to provide care appropriate to the population served.

• May vary work routines according to patient care priorities.

• Must be highly organized and detail oriented and able to function effectively in a multi-task environment.

• Strong knowledge of Medicare and Medi-Cal guidelines and insurance company standards.

• Proficient in billing industry standards relative to CMS 1500, UB, universal claim forms, and pharmacy D.O transmission requirements.

• Proficient skill level in Microsoft Office, Excel, and Word.

• Accustomed to integrating high volumes of written and verbal communication into daily responsibilities and follow through.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class