What are the responsibilities and job description for the Contract Specialist - Pharmacy position at M Health Fairview?
Requisition ID: 2024-141595
Profession: Business Operations
Specialty: Pharmacy
Requisition Post Information* : External Company Name: https://www.fairview.org
Location: Fairview offices at Kasota
Shift: day
Hours per 2 weeks: 80
Department: Contract Relations-Adj
Overview
As a member of the pharmacy team, the Contract Specialist manages and coordinates all financial information with third party plans to ensure contract and regulatory compliance. This position will have a strong knowledge of ambulatory pharmacy revenue cycle management and can skillfully use interpersonal, customer service, problem solving and collaboration skills to support and manage pharmacy revenue management activities. The Contract Specialist will also be responsible for new and existing Business and Contract analysis.
Responsibilities/Job Description
- Using pharmacy revenue management metrics and standard operating procedures, analyze proposed contracts, addendums and product lines for financial impact
- Review, research and respond to payor issues for ambulatory pharmacy service line
- Maintain a database with all regulatory compliance information
- Partner with third party plans to ensure accuracy of their records, notifying them of any relevant changes to pharmacy operations/credentialing
- Act as a subject matter expert in third party regulations and billing guidelines as pertains to Medicare benefits, and primary, secondary and tertiary insurance claims. Assist in resolving any billing issues, verifying eligibility and escalating as appropriate.
- Other responsibilities as assigned including but not limited to: process improvement and trend analysis, quality assurance and research
Organization Expectations, as applicable:
- Demonstrates ability to provide care or service adjusting approaches to reflect developmental level and cultural differences of population served
- Partners with patient care giver in care/decision making.
- Communicates in a respective manner.
- Ensures a safe, secure environment.
- Individualizes plan of care to meet patient needs.
- Modifies clinical interventions based on population served.
- Provides patient education based on as assessment of learning needs of patient/care giver.
- Fulfills all organizational requirements
- Completes all required learning relevant to the role
- Complies with all relevant laws, regulation and policies
- Performs other duties as assigned.
Qualifications
Minimum Qualifications to Fulfill Job Responsibilities:
Required
Education
- Baccalaureate degree in business or healthcare related field
Experience
- One year of experience in a pharmacy operation / business environment
Preferred
Experience
- Two years of revenue cycle, contracting, analytical experience in a complex healthcare organization.
