WVU Medicine Golisano Children's · 2 months ago
Lead Pharmacy Business Coordinator - Home Infusion
United States
Full-time
Remote
Mid, Senior Level
3+ years expWVU Medicine Golisano Children's is dedicated to providing quality healthcare, and they are seeking a Lead Pharmacy Business Coordinator to assist with training new employees and improve operational efficiency. The role involves managing payer discussions, conducting audits, and ensuring compliance with pharmacy operations and financial processes.
Responsibilities
Drafts various correspondence letters and sends to referral source when necessary
Gathers and documents demographics, insurance information, needs assessment, and other data as needed
Provides information and answers to patient/caregiver questions and refers to clinician when appropriate or requested
Identifies all patients requiring pre-certification or pre-authorization at the time services are requested or when notified by another hospital or clinic department
Enters pre-registration using the comprehensive data elements into the registration/billing
Contacts insurance company or employer to determine eligibility and benefits for requested services
Performs medical necessity screening as required by third party payers
Identifies managed care admission/treatment requirements and assures the requirements are met to guarantee payment of the account
Initiates charge anticipation calculations. Accurately identifies anticipated charges to assure identification of anticipated self-pay portions
Communicates with the patient the anticipated self-pay portion (co-payments/deductibles/co-insurance) and establishes payment arrangements based on the Financial Policy and documents the financial resolution in the registration/billing systems
Maintains current knowledge of major payor payment provisions and regulations
Maintains registration accuracy threshold of 98% as identified in audit processing
Participates in educational programs to meet mandatory requirements and identified needs with regard to job and personal growth
Attends departmental meetings and/ or documents review of meeting minutes
Participates in quality activities as assigned by department leadership to meet quality objectives
Participates in performance improvement (i.e. follows established work systems, identifies deviations or deficiencies in standards/systems/processes and communicates problems to coordinator or manager)
Maintains confidentiality according to policy when interacting with patients, physicians, families, co-workers and the public regarding demographic/clinical/financial information
Communicates problems hindering workflow to management in a timely manner
Demonstrates the knowledge and skills necessary to communicate to the infant, pediatric, adolescent, adult and/or geriatric patient per the established age-specific education/standard
Assesses all self-pay patients for potential public assistance through registration/billing systems
Obtains commitment to pay from patients that do not meet requirements for public assistance or full charity write off
Negotiating pharmacy reimbursement rates and language with Payers, establish strong relationships with senior staff members at the payer/ insurance organization and managing /maintaining pharmacy contracts
Maintains database that lists all pharmacy contracts that are currently on file. (both Retail and Specialty)
Performs routine contract reconciliation at prescription level detail
Reviews all pharmacy payer (Commercial & Government) contract terms, identify and report areas of concern or changes in contracts that could have a negative impact on the organization
Responsible for periodically reviewing pharmacy contracts (at least annually) for updates or changes in contract language as well as seeking higher reimbursement rates
Facilitates discussions with insurance companies to resolve payment issues and to identify payment, overpayments, and underpayments
Conducts claims extracts and payer payment evaluations to perform contract compliance tests
Organizes meeting materials and attends various organization meetings as needed
Manages customer service-related phone calls or written requests related to pharmacy contracting issues and ensure timely resolution
Comprehensive understanding of the 340B Drug Discount program in addition to assisting with compliance of program
Assists Manager or other leaders with training and orienting staff new to the coordinator role or other roles within the department
Assists Manager with budget planning, analysis, and forecasts
Assists Manager with leading team meetings, as well other departmental/organizational/vendor meetings
Leads team processes and operation in absence of the Manager
Provides team staff performance input to the Manager for evaluation and improvement purposes
Qualification
Required
Bachelor's Degree OR Nationally Certified Pharmacy Technician (PTCB or EXPT) upon hire
Pharmacy Business, Finance, Billing, or Reimbursement Certifications from an accredited organization such as ASHP, HFMA, or PTCB
Three years pharmacy experience
Experience in training, leadership, or other related specialized experience required
Preferred
PTCB Advanced Pharmacy Technician Certificate
Masters in Business Administration or Finance
Two (2) years working in a Specialty Pharmacy or Home Infusion Pharmacy
Two (2) years Leadership experience
Knowledge of drugs, drugs dosing, side effects, indications, contraindications, and proper administration
Knowledge of rules, policies and regulations related to the disbursal of pharmaceutical drugs
Knowledge of clinical procedures or operations
Company
WVU Medicine Golisano Children's
WVU Medicine Golisano Children’s is home to the state’s largest—and most experienced—group of pediatric primary care physicians and specialists.
501-1000 employees
H1B Sponsorship
WVU Medicine Golisano Children's 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 (9)
2024 (11)
2023 (9)
2022 (9)
2021 (7)
2020 (6)
Funding
Current Stage
Late StageCompany data provided by crunchbase