Pharmacy Reimbursement Coordinator

CommonSpirit Health; Colorado Springs (CO); On-site; USD 70,000 - 90,000; Full time

Job summary

CommonSpirit Health is seeking a Pharmacy Reimbursement Coordinator in Colorado Springs to join the pharmacy team and ensure outpatient drug reimbursement integrity. You will conduct research, audits, data management, and cost-benefit analyses to drive financial improvements.

You will report to the Director of Pharmacy, analyze payer processing issues, and collaborate with finance and revenue teams to minimize risk and maximize revenue. Strong analytical and collaboration skills are essential.

Qualifications

• Bachelor's degree or four years of healthcare administrative/technical experience.
• Strong analytical and data management capabilities.
• Experience with healthcare financial applications and reimbursement processes.

Responsibilities

• Perform drug reimbursement analysis and develop reports for root cause analysis of unpaid or underpaid accounts.
• Assist leadership in strategies to minimize financial risks related to outpatient reimbursement.
• Report key financial metrics to finance and pharmacy leadership to meet targets.
• Collaborate with revenue integrity, finance and other teams to optimize reimbursement outcomes.
• Prepare reports and recommendations to track revenue and recover lost revenue for outpatient services.
• Analyze internal processes and payer/system issues affecting revenue capture.

Skills

Analytical skills

Data management

Healthcare financial applications

Collaboration

Discretion

Education

Bachelor's degree

4 years healthcare admin/technical experience

PHARMTECH:XX License

Tools

PHARMTECH:XX License

Job description

Job Summary and Responsibilities

As our Pharmacy Reimbursement Coordinator, you will be a key member of the pharmacy team, crucial for ensuring the financial integrity of outpatient drug reimbursement. Every day, you will conduct research, perform audits, manage data, and consolidate, analyze, and perform cost-benefit and trend analyses. You will effectively navigate multiple vendor-based healthcare and financial applications, collaborating with other entities. You will also assist the Director of Pharmacy with auditing activities, budget analysis, pharmaceutical reimbursement, revenue integrity, and report generation to drive financial improvements. To be successful in this role, you will possess strong analytical and data management skills, a solid understanding of healthcare financial applications, and a commitment to financial integrity. Your ability to work collaboratively, exercise discretion, and independently judge sensitive information will be essential in navigating restricted, confidential, and patient data.

• Perform drug reimbursement analysis; develop and analyze reports that allow root cause analysis on unpaid/underpaid accounts tracking loss, recovery, and margin over time.
• Assists Pharmacy leadership and key stakeholders in developing strategies to minimize financial risks associated with outpatient medication reimbursement.
• Report ongoing key financial metrics to finance and pharmacy leadership teams to ensure desired targets are achieved.
• Collaborate with revenue integrity, finance, and others to optimize medication reimbursement outcomes.
• Prepare reports, predictions, and develop recommendations based on research to track, manage, avert loss of, and recover revenue related outpatient pharmacy services.
• Analyze internal processes, technical system issues and payer processing/system issues that contribute to revenue capture opportunities.

Job Requirements

Required

• Bachelor's Degree or four (4) years of administrative or technical experience in a healthcare environment
• Three (3) years of professional work experience in a healthcare field
• PHARMTECH:XX License

Preferred

• CPTEXCPT CPTPTCB or CPHT
• Three (3) years of experience in business acumen, insurance or managed care industry, hospital patient accounts or a related healthcare area such as utilization management, case management or hospital audit and reimbursement

Where You'll Work

Penrose - St. Francis Health Services is a full-service, 712-bed acute care provider in Colorado Springs comprising Penrose Hospital, St. Francis Hospital and St. Francis Hospital - Interquest. Penrose Hospital serves as the anchor hospital of Penrose-St. Francis Health Services with 300-licensed beds and the ability to provide tertiary (high tech) medical-surgical services with an emphasis on elective and outpatient care. Established in 1890, Penrose Hospital has grown to become a major health treatment and referral center, specializing in cancer care, cardiac care, emergency trauma care and physical rehabilitation. It's an incredible time to join us as we are a proud Magnet Hospital with designation from the American Nurses Credentialing Center (ANCC) for superior quality in nursing care. With more than 300 days of annual sunshine, mild winters and easy-to-access recreational areas like Pikes Peak, Garden of the Gods and some of Colorado's top destination resorts, you will enjoy an incredible lifestyle while having the career you've always wanted.