**Primary City/State:**
Arizona, Arizona
**Department Name:**
Admin-Misc
**Work Shift:**
Day
**Job Category:**
Pharmacy
A rewarding career that fits your life. As an employer of the future, we are proud to offer our team members many career and lifestyle choices including remote work options. If you’re looking to leverage your abilities – you belong at Banner Health.
**Banner Health was recognized on Becker's Healthcare 2024 list of 150+ top places to work in healthcare. This list highlights hospitals, health systems and healthcare companies that prioritize workplace excellence and the happiness, satisfaction, wellbeing and fulfilment of their employees.**
As a **Pharmacy Third Party Consultant** you will be tasked with providing results on an innovative and individualized basis where you will likely need to problem solve in order to produce results. Experience as a Pharmacy Technician, working with data analytics and 340B will be helpful in this role. You must be proficient in Excel, pharmacy/hospital billing, data compilation, use of Cerner, Macro Helix, and Contract Pharmacy for this position. **Your schedule will be Monday to Friday 8AM - 4:30PM with some flexibility, working remotely.**
Your pay and benefits are important components of your journey at Banner Health. This opportunity includes the option to participate in a variety of health, financial, and security benefits.
Banner Pharmacy Services is a recognized leader in healthcare and trusted partner in proactively providing innovative pharmacy services through excellence in integration, care coordination, medication management and services to make a difference in people's lives. Clinical Pharmacy Services is responsible for the management of the Banner formulary, development of standardized system wide clinical pharmacy services, and management of adverse drug event preventions. Clinical Pharmacy Services provides collaborative drug therapy management and educational interventions in patient care to optimize medication therapy, improve outcomes, promote wellness, and disease prevention. As a division, Banner Pharmacy services provides excellent patient care across our entire continuum through convenient access, improved medication outcomes and innovative pharmacy practices.
POSITION SUMMARY
This position will accurately facilitate and coordinate external desktop and on-site payer audits. Provide support and work collaboratively across the organization on third party billing processes. Review and maintain patient and third-party AR systems. Coordinate third party credentialing and contract maintenance for the department. Coordinate license renewals for all outpatient pharmacies. Problem solve and expedite communication to pharmacy leadership to ensure optimal outcome.
CORE FUNCTIONS
1. Investigate and ensure accuracy of pharmacy third party reconciliation processes. Review, maintain, and adjust patient AR accounts to ensure accuracy. Provide support for pharmacy team members with complex billing issues. Monitor and reconcile third party payments. Communicate internally and externally with appropriate parties to resolve billing issues.
2. Manage balances by working communication from patients and payers including denials, returned mail and refund requests. Coordinate and oversee distribution of monthly patient statements. Work with patients to resolve any discrepancy.
3. Research and identify solutions to billing inquiries related to patient AR accounts and coordinate monthly interdepartmental billing with accounting office.
4. Facilitate stat requests for HCFA 1500 forms for submission to patient's medical benefit and address complex pharmacy billing issues.
5. Execute on contracting, auditing, and credentialing requirements for third party payers including commercial, Medicare and Medicaid. Facilitate legal requests to initiate and maintain pharmacy third party contracts.
6. Complete all necessary credentialing and re-credentialing for all pharmacy locations as required by individual third-party payers. Complete, maintain, and acquire out-of-state Medicaid contracts as dictated by business and patient care needs. Investigate and respond to audit requests for third party desktop and on-site audits for all outpatient and specialty pharmacy areas. Coordinate with all appropriate teams and lead processes for all onsite audits. Report results of third-party audits appropriately
7. Ensure competency with third party billing requirements, monitor and communicate upcoming changes, and work collaboratively with pharmacy leadership to implement necessary changes.
8. Train pharmacy team members when third party billing problems are identified and assist in implementation of solutions to prevent future occurrences. Review and analyze current patterns, processes and strategies to develop or improve methods that will meet changing organization requirements.
9. This position will work in concert with Clinical Aps Team H, Retail Pharmacy Services and Pharmacy Revenue Cycle to provide system setting recommendations, setting and testing of pricing tables and revenue collection follow up to ensure revenue integrity is maintained for cash and third-party pricing. This position will require minimal supervision but will need to review and test all system changes with all system partners.
MINIMUM QUALIFICATIONS
Bachelor Degree or equivalent working knowledge. Minimum of two years of healthcare, pharmacy, business, or finance experience required. Strong customer service focus, superior problem-solving abilities. Demonstrated effective communication skills, both written and verbal required.
Ability to interpret financial/statistical data and make sound recommendations based on that information required. Ability to anticipate customer requirements and meet those needs in an appropriate and timely manner is required. Ability to prioritize organization requirements and track progress of multiple initiatives required. Proficiency in Microsoft Word and Excel required.
PREFERRED QUALIFICATIONS
Master’s Degree preferred or equivalent combination of education/experience combined.
Certified Pharmacy Technician, AZ Pharmacy Technician License. Three years' experience working in a healthcare, pharmacy, business or finance and/or experience working in a Third-Party Administrator role. Knowledge of manufacturer/vendor product catalogs is preferred.
Knowledge of medical terminology and hospital financial systems is preferred.
**EEO Statement:**
EEO/Female/Minority/Disability/Veterans (https://www.bannerhealth.com/careers/eeo)
Our organization supports a drug-free work environment.
**Privacy Policy:**
Privacy Policy (https://www.bannerhealth.com/about/legal-notices/privacy)
EOE/Female/Minority/Disability/Veterans
Banner Health supports a drug-free work environment.
Banner Health complies with applicable federal and state laws and does not discriminate based on race, color, national origin, religion, sex, sexual orientation, gender identity or expression, age, or disability