Stanford Health Care · 2 months ago
Clinical Pharmacist – Pharmacy Billing Senior Specialist – Finance Business Ops
United States
Full-time
Remote
Senior Level
$79.21/hr - $104.97/hr
7+ years expStanford Health Care is a leading healthcare provider, and they are seeking a Clinical Pharmacist – Pharmacy Billing Senior Specialist. This role involves advanced analysis of pharmacy billing data, collaboration with cross-functional teams to enhance billing accuracy, and support for complex Pharmacy Revenue Cycle functions.
Health CareHealth DiagnosticsHospitalMedicalPrimary and Urgent Care
Responsibilities
Independently reviews and analyzes complex Pharmacy billing and claims data to identify discrepancies, compliance issues, and reimbursement risks across multiple payer types
Applies advanced analytical methods to detect trends, forecast potential issues, and support data-driven decision-making for Pharmacy Revenue Cycle workflows
Contributes to the development and refinement of scalable audit frameworks and monitoring processes, ensuring consistent enterprise-wide review of charges and claims on a regular basis
Works proactively and independently to identify billing or workflow issues, escalate appropriately, and drive timely resolution under managerial guidance
Investigates and resolves complex billing issues, collaborating with Revenue Cycle, Compliance, and TDS to implement corrective actions and improve process reliability
Supports denial resolution by performing root-cause analysis and contributing to targeted denial prevention strategies across pharmacy billing workflows
Provides advanced subject-matter expertise to pharmacy staff and stakeholders regarding billing compliance, coding guidelines, and payer requirements. Research, interpret, and apply complex payer and regulatory guidance to resolve escalated issues and support Pharmacy Revenue Cycle Manager in developing consistent practices
Collaborates with cross-functional teams to improve charge capture workflows, documentation practices, and reimbursement processes
Assists in enhancing and maintaining pharmacy billing dashboards and performance metrics, contributing insights for performance improvement
Participates in or leads operational initiatives aimed at improving accuracy, efficiency, and compliance of the Pharmacy Revenue Cycle
Develop, analyze and maintain key performance indicator (KPI) data for Pharmacy Billing Dashboard. Lead enhancement to dashboard functionality, ensure data accuracy and integrity, and translate findings into actionable insights for performance improvement across pharmacy revenue cycle operations
Lead or provide support for ad hoc projects or departmental initiatives, including participation in committees as assigned
Lead communication and education efforts for Clinic Administration, Clinic Managers and clinic staff on complex pharmacy-related matters, including regulatory and compliance updates, relevant FDA drug recalls, and drug information, specialty programs, and investigational studies. Develop and implement standardized education and communication tools to ensure consistent adherence to evolving regulations and alignment with SHC policies
Refine and standardize Pharmacy Technician workflows and SOPs relating to billing in collaboration with pharmacists, technicians, and leadership. Identify process gaps and recommend practical improvements to enhance consistency, efficiency, and compliance across assigned areas
Develop, update, and maintain SOP for pharmacy billing specialist workflow under the direction of Pharmacy Revenue Cycle Manager. Ensure procedural accuracy, alignment with compliance standards, and practical applicability across pharmacy billing operations
Qualification
Required
PharmD Degree from an accredited college/university required
Seven (7) years of progressively responsible and directly related work experience required
Knowledge of healthcare financial operations
Knowledge of healthcare regulations and policies affecting pharmacy billing, reimbursement, and financial compliance at both federal and local levels
Knowledge of other relevant regulatory guidelines (e.g., CMS, 340B, FDA)
Knowledge of the Pharmacy Revenue Cycle, including charge capture, claim submission, reimbursement methodologies, and denial management
Knowledge of and demonstrated proficiency in the use of office and data analysis tools (Word, Excel, PowerPoint, Visio, Access, Project and Outlook)
Knowledge of project management process and systems
Knowledge of theories, principles, practices and techniques of personnel management, including selecting, training, directing, evaluating, and supervising employees
Excellent attention to detail, organizational skills, and the ability to manage multiple priorities independently
Ability to interpret complex financial or billing datasets
Ability to implement large-scale initiative that requires cross-functional coordination
Ability to mediate and resolve complex problems and issues
Ability to develop financial budgets and manage expenses
Ability to develop long-range business plans and strategies
Ability to develop and maintain productive and cooperative work relationships at all levels both within and outside the organization
Ability to communicate effectively at all organization levels and in situations requiring instructing, persuading, negotiating, conflict resolution, consulting and advising as well as prepare clear, comprehensive written and oral reports and materials
Ability to effectively manage and promote staff development
Ability to articulate strategic planning
Ability to lead process excellence team to effectively improve operational efficiencies
Ability to manage financial performance process including accuracy of submission
Demonstrated skills in analytical assessment, oral and written communication
Strong communication skills and ability to promote and maintain interpersonal relationships
RPH - Registered Pharmacist required
Company
Stanford Health Care
Stanford Health Care is a healthcare center that treats cancer, heart disease, brain disorders, and primary care issues.
10001+ employees
H1B Sponsorship
Stanford Health Care has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (102)
2024 (74)
2023 (82)
2022 (55)
2021 (54)
2020 (67)
Funding
Current Stage
Late StageLeadership Team
Aditya Bhasin
VP Software Design & Development
Jay Shah
Chief of Staff
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