Job Overview

Employment Type:

Full time

Shift:

Day Shift

Description:

VERY Flexible - 4 - 10-hour day; 5 - 8-hour days NO WEEKENDS< NO HOLIDAYS

POSITION PURPOSE:
The Finance/Billing Lead – Retail Pharmacy provides for coordination of the Retail Pharmacy business office billing and accounting functions. Serves as a resource for all Retail Pharmacy reimbursement, billing, regulatory and compliance issues including Long Term Care, Hospice, Skilled, Retail, Medicare, 340B, etc. Leads personnel in the standards of the office accountability and communication within the Retail Pharmacies as it relates to accounting procedures. Acts as a liaison between retail pharmacy and finance department. Assists the Director of Finance to attain objectives related to Retail Pharmacy business functions. Collaborates with the Director of Pharmacy and Retail Pharmacy staff to achieve operational indicators.

SCOPE OF SERVICE:
Clients and their families/significant others, third party insurance companies, regulatory bodies, colleagues from all MercyOne Retail Pharmacies and finance staff.

ESSENTIAL FUNCTIONS:

1. Adheres to the principles of caring and expected behaviors outlined in MercyOne Dubuque Medical Center's Model of Caring and Trinity Health's Code of Conduct, fostering a climate where all customers are treated in a manner consistent with MercyOne Dubuque Medical Center's Mission and Values.

2. Maintains a working knowledge of applicable Federal, State and local laws and regulations, Trinity Health’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.

3. Performs other duties consistent with purpose of job as directed.

4. Completes daily, weekly, monthly and yearly financial/banking/accounts receivable duties. (Including bank deposits, entering/balancing daily sales entries, account reconciliation, monthly statements, financial reporting etc.)

5. Produces financial reports for management and the finance department monthly and as needed.

6. Prepares journal entries for finance staff to record.

7. Responsible for oversight of timely and accurate claims submission, billing and collection procedures and regulatory compliance including Long Term Care, Hospice, Skilled, Retail, Medicare, etc.

8. Reviews and applies third party and individual patient payment to appropriate accounts.

9. Coordinates and acts as a resource for matters related to business office functions, reimbursement, billing, collections, and regulatory requirements in Retail Pharmacy.

10. Understands monitors and educates others on the revenue cycle related to Retail Pharmacy.

11. Actively monitor days in accounts receivable by working with the aged trial balance for outstanding receivables not paid within 60 days and performs necessary follow-up or activity required to resolve the outstanding receivable.

12. Assures that all receivables are paid, adjusted or sent to collections in a timely manner.

13. Monitors collection activity for all sites, review accounts to be written-off or refunded with Director of Finance for approval.

14. Reconciles accounts receivable reports to posting activity and daily log.

15. Responsible for ensuring all month end processes and reports are completed in an accurate and timely manner.

16. Works closely with pharmacy and financial assistance departments to help mitigate cost as a barrier to medication compliance.

17. Follows financial assistance guidelines to assist in approval of and maintenance of financial assistance for pharmacy customers, balancing financial stewardship with our commitment to those who are poor.

18. Generates and mails statements to customers monthly.

19. Track and submit grants.

20. Ensures that new processes or systems i.e. electronic billing and related functions are current and accurate.

21. Contacts 3rd party payers or physician offices as appropriate to resolve third party prescription payment issues (including prior authorization, step therapy, processing questions etc)

22. Responds quickly and appropriately to customer request for clarification of accounts.

23. Unbilled claims processing and special billing.

24. Review pricing for accuracy and resolves discrepancies.

25. Combine patient profiles as needed.

26. Responds promptly to and takes the lead on audit requests.

27. Maintains QS1 access by setting up or terminating user ID's. Assist with QS1 issues. Actively leads training of new colleagues.

28. Actively leads and participates in LEAN, quality and problem solving activities with other pharmacy staff, finance and other hospital departments.

SKILLS AND ABILITIES REQUIRED:

1. Maintains a professional, collaborative work environment so as to foster a positive public image for MercyOne Dubuque Medical Center.

2. Knows and adheres to all laws and regulations pertaining to patient health, safety and medical information (i.e. HIPAA, Stark, etc.)

3. Provides a high level of customer responsiveness and serves as a role model to encourage a commitment to customer service. A strong service orientation is required.

4. Maintains an excellent working relationship within the department and with all of our internal and external customers.

5. Ability to handle interactions with discretion, tact and courtesy when dealing with sensitive issues and confidential information.

6. Must have well developed communication skills; strong interpersonal and collaborative skills with physicians and other healthcare professionals; strong decision making skills that support

patient care needs and ethical standards; and the ability to organize work and set appropriate priorities.

7. Must have excellent written and verbal communication skills with the ability to relate to people across all levels and diverse backgrounds.

8. Ensures that services are provided in a manner that supports continuous quality improvement and customer-oriented focus.

9. Keeps supervisor informed about important issues.

10. Requires professionalism in both dress and conduct on the job.

11. Demonstrates an understanding of organizational dynamics and administrative procedures and protocols. Ability to function in a dynamic, fast-paced team environment and to cope with ambiguity, time constraints, and other daily stressors in an effective and appropriate manner.

12. Demonstrates time management, prioritization and organizational skills including an ability and willingness to plan, organize and accomplish tasks accurately and in a timely manner to exercise sound judgment under pressure and to manage multiple and competing activities simultaneously.

13. Must be able to work independently and productively in a fast paced setting involving multi-task functions and projects. Ability to plan, organize and perform duties with minimal supervision and with a high degree of accuracy and attention to detail.

14. Proven ability to identify, compile and present data effectively from many different sources for management decision-making.

15. Must possess advanced analytical skills with the ability to analyze data and effectively communicate the analysis.

16. Knowledge of accounting theory and procedures.

17. Ability to lead and coordinate others in the activities of the department and to deal with outside auditors and departmental supervisors to resolve issues and ensure accuracy of financial information.

18. Possess an intermediate to expert-level understanding of Excel, Microsoft Office and Word applications.

19. Ability to demonstrate initiative.

20. Ability to be able to detect and solve non-compliance and system issues.

21. May require the ability to be cross-trained into multiple positions.

22. Assigned hours within your shift, starting time, or days of work are subject to change based on the changing needs of the department and/or the organization.

PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS:

1. Normal office environment where there are relatively few physical discomforts due to dust, dirt and noise.

2. During an 8-hour day, an associate must be able to stand/walk for 3 hours and sit 5 hours.

3. Job requires occasional (<10% of work time) squatting, crawling, crouching, kneeling, and balancing; frequent (21-50% of work time) bending, stooping, reaching above shoulder level, pushing and pulling.

4. Job requires the ability to frequently (21-50% of work time) lift and carry objects weighing approximately 11-24 pounds.

5. Job requires exposure to marked changes in temperature and humidity and may be exposed to infectious disease, hazardous waste and chemicals. (this is for non-office roles)

6. Must have fine motor and manual dexterity skills to grip and manipulate items and perform repetitive action such as computer entry.

7. Requires visual acuity, the ability to speak and the ability to hear speech.

8. Job requires high level of mental concentration to attain established deadlines. Working environments includes frequent interruptions.

9. Must be able to travel on occasion to other worksites and training seminars.

10. Must adhere to applicable organizational requirements on an annual basis for Employee Health Directives.

MINIMUM QUALIFICATIONS & CORE COMPETENCIES

(EDUCATION, LICENSURE, CERTIFICATION, AND EXPERIENCE REQUIRED):

1. Education, Licensure and Certification

A. Child and Dependent Adult Abuse Mandatory Reporter Training is required within 6 months of hire and every 5 years thereafter.

B. High school (or equivalent) graduate is required.

C. Bachelor, Associate degree in accounting preferred.

2. Experience:

A. Retail or Long Term Care or Medicare B Pharmacy background preferred.

B. Prefer knowledge of electronic billing systems and PC applications.

3. Special Skills, Competencies, and Aptitudes:

A. Possess an intermediate to expert-level understanding of Excel.

B. Computer Proficiency: Demonstrated experience and competency with Microsoft Office Suite, e-mail and a variety of web-based programs and browsers, with the willingness and ability to update and increase skills as needed to meet the goals of the departments. Ability to use other software as required to perform the essential functions of the job.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.