Providence Manager Pharmacy Business - Health Information Management in Tukwila, Washington
Providence is calling a Manager Pharmacy Business - Health Information Management (Health Information Management, Day Shift, 1 FTE) to Providence Infusion & Pharmacy Services in Tukwila, Washington. We are a community of caregivers delivering every day on our Mission to provide compassionate care that is accessible for all - especially those who are poor and vulnerable.
In this position you will:
Manages pharmacy business operations, including health data services, medical records, accounts payable, reception/customer service, benefits investigation, prior authorization. assuring high quality and timely services are provided to patients, staff, referring providers, and other customers.
In collaboration with director, finance manager, billing manager, and business line leaders, manages the revenue cycle process ensuring appropriate coding, billing, and reimbursement for services provided, and visibility of process metrics for situational awareness.
Interfaces with reimbursement department manager to validate that all insurance and authorization processes result in compliant patient notification and documentation, and effective billing and collections.
Coordinates payor and other audit requests with stakeholders, ensuring that information requested is provided within the required time frame, and that audit results are reviewed and validated, or challenged. Audit results are tabulated, reported and process improvement initiated when appropriate.
Oversees payor and vendor contract tracking system and maintains contract reference library and other billing references. Proactively reviews payor contract and policy changes for operational implications, taking appropriate early action to ensure compliance while preventing loss.
Ensures that contracts and service agreements are established, maintained, and routinely updated for content and terms.
Required qualifications for this position include:
Bachelor's Degree in Business Administration, Healthcare Administration, Finance, or a closely related field.
1 year of management experience in a healthcare environment.
3 years of Pharmacy business-related experience
Washington State Pharmacy Assistant registration required
Broad working knowledge of health care systems, including billing/collection, general ledger, payroll, patient care, and other subsidiary systems is required.
Working knowledge of medical and pharmacy billing, including ICD and HCPCS coding systems, NCPCD prescription claim process, and HCFA1500 and UB-92 claim process.
Extensive knowledge of provider/payor relationships, regulatory requirements and contract language and implications associated with payor contracting is required
Demonstrated sustained success in financial management and analysis, contract management, customer service, and people management is required.
Integrate and analyze financial data with other patient related data to meet the needs of financial and non-financial users.
Preferred qualifications for this position include:
Master's Degree in Business Administration, Healthcare Administration, Finance, or a closely related field
1 year of Management experience in a pharmacy business-related environment
Vendor or payor contract negotiation experience
Lean and Six Sigma training and experience
Licensed pharmacy technician preferred
About the ministry you will serve.
Providence Infusion and Pharmacy Services in Tukwila and Spokane, Washington provides pharmaceutical services to patients in communities throughout Washington, Alaska, Idaho and Montana. Patient safety, patient satisfaction, and clinical outcomes are our priorities. Our services include nutrition and pharmacological therapies to patients in their homes or in our Ambulatory Suites, disease management and related specialized infusion therapies, and clinical nurse, pharmacist, and nutrition consulting and support services.
For information on our comprehensive range of benefits, visit:
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Non-Clinical Lead/Supervisor/Manager
Req ID: 269470