Senior Clinical Staff Pharmacist - Revenue Integrity and Patient Access

REQUIRED EDUCATION / EXPERIENCE:

Doctor of Pharmacy or Bachelor's degree in Pharmacy from an accredited College of Pharmacy and four (4) years of experience. Current licensure or eligible for licensure to practice from the Texas State Board of Pharmacy.

JOB SUMMARY:

Senior Clinical Staff Pharmacist provides advanced professional and supervisory skills in the management of pharmacy operations and procedures in the area of responsibility.

ESSENTIAL JOB FUNCTIONS:

• Performs all pharmaceutical care and drug distribution duties required of Clinical Staff Pharmacist.
• Manages, supervises, and evaluates staff, residents, and supportive personnel.
• Trains and orients all departmental staff in departmental and hospital procedures.
• Develops and maintains departmental operational policies and procedures including ongoing quality assurance standards and measures.
• Prepares and maintains performance evaluation standards, budget request, and time and motion data.
• Identifies, documents, and follows-up on problems related to inter and intra departmental operations and patient safety.
• Provides in-service education directed toward the training and development of UTMB health care providers.
• Participates in the recruitment, interviewing, and selection of qualified staff members.
• Develops the ongoing educational activities of the department.
• Adheres to internal controls established for department.
• Revenue Integrity and Patient Access related functions:
• Evaluates and reviews all prior authorization requests and render coverage determinations based on clinical criteria and plan design.
• Includes verifying insurance coverage and eligibility, interpreting clinical guideline criteria, consulting physicians and other healthcare providers, and appropriately utilizing clinical knowledge and resources to identify formulary alternatives or qualification for co-pay, drug replacement, and/or patient assistance programs when appropriate.
• Ensures orders are sent to and patients are referred to the appropriate outpatient pharmacy or infusion clinic when appropriate.
• Reviews payer contracts/medical coverage policies to understand reimbursement terms and ensure accurate billing based on contract/policy specifications.
• Manages and completes daily infusion referrals work-queues for accuracy and completeness prior to payer submission in a timely manner.
• Identifies and addresses discrepancies in charge capture practices for infusion services by reviewing documentations for appropriate level of detail to support billing codes.
• Assists with developing strategies to prevent future denials by addressing issues with documentation, coding, and billing practices.
• Partners with health system billing/revenue cycle team to appeal denied claims where appropriate.
• Assist with generating reports on key revenue integrity metrics, such as charge capture rates, coding accuracy, denial trends, etc.
• Utilize data analytics tools to identify areas for improvement and prioritize revenue integrity initiatives.
  

Equal Employment Opportunity

UTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. As a VEVRAA Federal Contractor, UTMB Health takes affirmative action to hire and advance women, minorities, protected veterans and individuals with disabilities.

Primary Location

United States-Texas-Galveston

Work Locations

0401 - Clinical Services Wing

Job

Allied Health

Organization

UTMB Health

Regular

Shift

Standard

Employee Status

Non-Manager

Job Posting

Jan 30, 2025, 3:08:58 PM