JOB LISTINGS

ESSENTIAL DUTIES AND RESPONSIBILITIES.

• Collaborates with key leadership, other employees, and pharmacists to identify, research, and investigate compliance issues related to pharmacy.
• Documents external regulatory investigations and audits related to pharmacy compliance into the compliance database.  
• Monitors, analyzes, interprets, and communicates regulatory changes related to pharmacy.  Oversees efforts to respond to new or changing regulations, including but not limited to communicating regulations to site leadership and affected departments, assembling and chairing work teams, and providing education regarding regulatory requirements.
• Assist leadership in development of compliance policies and procedures related to pharmacy. 
  Tracks data and creates reports to assist in the analysis of compliance issue patterns.
  Reduces organization risk by identifying risks related to pharmacy and reporting to leadership.
• Delivers education related to pharmacy, compliance, using on-line training courses, in-person educational presentations, guideline documents, newsletters, the Compliance website and other educational tools.
• Works with Human Resources to investigate suspected employee misconduct.
• Participates in projects related to the design, implementation, revision and maintenance of processes and systems that promote compliance related to dispensary.
• Serves as internal expert and advisor in compliance matters related to pharmacy.
• Assist patient with efficient and effective financial assistance thus decrease financial toxicity to the patient and improve adherence to oncolytic treatment
• Assist appropriate patients and families with referral to Social Services when appropriate.
• Obtain necessary insurance information and financial documents from patients
• Answer questions or directs patients to appropriate staff members for questions regarding insurance, billing, payment, and/or collection arrangements.
• Updates the pharmacy system on foundational grants status and searches for additional grants when funds are insufficient
• Investigates and assist in the rebilling of claims for foundational grants
• Manages billing queries for assigned foundation assistance programs to insure timely receipt of payments
• Evaluate data and correct all errors to ensure appropriate billing and coding
• Ensure that all procedures and records are in compliance with all state, federal, and industry standard requirements.
• Provide, guide, and educate clinical team on various financial resources and compassionate drug programs regarding the accessibility of pharmaceutical products
• Collaborate with all manufacturer PAP programs and their designated PAP pharmacies to insure continuity of oncolytic supply to improve patient adherence to treatment. 
• Align financial assistance with pharmacy operation to maximizes the efficiency and productivity of the pharmacy and delivery operations.
• Provide management with routine quarterly updates on key performance measures regarding the productivity and efficiency of the financial assistance program.
• Completion of pharmacy credentialing and re-credentialing applications.
• Data entry of applications and other records in the credentialing database.
• Maintain the credentialing database and ensure up-to-date information is obtained at all times. •
• Maintains working knowledge of Specialty Pharmacy Credentialing standards for ACHC and URAC and State and Federal regulations related to credentialing.
• Perform and collect PSV (primary source verification) documentation for licensing, board certifications, proof of professional liability insurance, and NCPDP as required based on ACHC and URAC standards, health plan requirements and company credentialing policies.
• Responsible for monitoring and managing credentialing/re-credentialing requirements and to ensure the collection of all required certifications are on file within the required time frame.
• Provide consistent and timely follow-up on all outstanding credentialing/re-credentialing files.
• Prepare and scan credentialing/re-credentialing files and other credentialing documentation into scanning software.
• Attend monthly credentials committee meetings as requested by manager.
• Communicate to credentialing bodies and networks of any changes
• Participate in various educational/training as required.
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• Perform other related duties as assigned by management.
• Comply with HIPAA and Corporate Compliance program policies and other applicable corporate and departmental policies.
• Maintain privacy and confidentiality at all times

Requirements

• Knowledge, skills and abilities required to perform this job are typically acquired through a minimum of five years of progressively responsible experience within a health care environment that includes experiences in retail pharmacy and billing; implementing regulatory changes; identifying, investigating, and resolving complaints; and analyzing and interpreting pharmacy requirements.
• Knowledge of state and federal laws and regulations related to pharmacy operations.
   
• Strong planning and problem-solving. 
   
• Demonstrated personal traits of a high level of motivation, team orientation, professionalism and trustworthiness, and placing a high value on treating others with dignity and respect.
• Strong written and oral communication skills
   
• Strong skills in personal diplomacy with demonstrated ability to handle sensitive communications with leadership, physicians, management, legal counsel and regulatory agencies.
   
• Strong organizational and time management skills.
   
• Demonstrated proficiency in the Microsoft office (Word, Excel, and PowerPoint) or similar products

CERTIFICATES, LICENSES, REGISTRATIONS: .

• Current Pharmacy Technician with TSBP with good standing
• Current PTCB with good standing
• College degree preferred

PHYSICAL DEMAND:  

• Operates all equipment necessary to perform the job.
• Must be able to drive to various sites so therefore will be exposed to weather and road conditions.

WORK ENVIRONMENT:

• Exposed to normal office environment.
• Ability to work independent to attain company goals.