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Day - 08 Hour (United States of America)

This is a Stanford Health Care job.

A Brief Overview

The Pharmacy Pricing & Compliance Specialist manages and maintains the accuracy, compliance, and optimization of the Pharmaceutical Charge Description Master (CDM) and related processes within SHC. This role supports Pharmacy Revenue Cycle and Business Operations through regular data analysis, ensuring medication charges align with the current formulary, pricing policies, regulations, and payer requirements. The specialist ensures pharmaceuticals are accurately recorded and priced based on approved cost bases and mark-ups, and collaborates with pharmacy, revenue cycle, finance, compliance, and SHC TDS to maintain billing integrity and support financial sustainability.

Locations

Stanford Health Care

What you will do

+ 1. Pharmaceutical Chargemaster Maintenance & Compliance• Oversee and maintain the pharmaceutical chargemaster, ensuring that all pharmaceutical products are accurately priced and coded.• Ensure that all new pharmaceutical products and/or new formulary items are added to the chargemaster in timely manner, ensuring correct codes (e.g. HCPCS, NDC), billing units, prices, and mark-ups.• Ensure timely updates and management of seasonal flu vaccines in the Charge Master to reflect changes in pricing and availability.• Ensure linking of correct procedure and charge mapping.• Performs detailed and regular audit for timely updates that reflect current codes, costs, pricing, and mark-ups.• Maintain various coding, pricing, mark-up databases and records for reporting.• Utilize a strong understanding of Pharmaceutical Chargemaster, revenue cycle applications, operational workflows, and regulatory policies to ensure compliance and to assist in analytic evaluations.

+ 2. Coding, Charge Capture & Auditing• Perform coding ensuring accuracy and timeliness, utilizing a software (e.g. Vitalware) for cross referencing HCPCS/NDC and assigning corresponding codes in EHR (e.g. Epic).• Perform detailed and regular charge audits for missed, system error, or high-cost pharmaceuticals and ensure correct charges are entered.• Perform review and enter charges for CAR-T therapies in timely manner.• Complete regular root cause analysis of incorrect codes, prices, and mark-ups for correction, mitigation, and prevention.

+ 3. Financial Analysis & Reporting• Examine historical and projected financial data to provide stakeholders with valuable information upon which to make operational decisions.• Prepare summary findings of analysis for Pharmaceutical Pricing Oversight Committee.• Analyze, prepare, and coordinate distribution of various financial reports for internal Revenue Cycle use and as required for external constituents.• Monitors key performance indicators for assigned areas and explores reasons for performance fluctuation and deterioration.• Develop and manipulate large data sets.

+ 4. Collaboration & Relationship Management• Cultivate internal and external relationships to assist in understanding department workflows.• Engage regularly with Revenue Cycle team, Pharmacy, TDS on improvement opportunities identified through data analysis.

+ 5. Strategic Initiatives & Other Duties• Engage in benchmarking activities to assess performance against industry standards and implement best practice.• Provide analytics for and support special projects as needed.• Complete other assignments based on the department needs.• Scope may include Stanford Tri-Valley pharmaceuticals, and other areas such as Stanford radiopharmaceuticals.

Education Qualifications

+ Doctor of Pharmacy (PharmD) or equivalent required.

Experience Qualifications

+ Three (3) years of progressively responsible and directly related work experience in pharmaceutical billing, coding, 340B or chargemaster management, preferably in a healthcare or hospital setting.

+ Experience in pharmacy operations, revenue cycle, informatics, or compliance.

+ 1-2 years of statistical analysis experience preferred.

Required Knowledge, Skills and Abilities

+ Ability to analyze and develop solutions to complex problems.

+ Ability to apply judgment and make informed decisions.

+ Ability to manage, organize, prioritize, multi-task and adapt to changing priorities.

+ Ability to communicate complex concepts in simple form to non-finance users to understand the appropriate use and limits of information provided.

+ Ability to communicate effectively in written and verbal formats including summarizing data, presenting results.

+ Ability to work independently and as part of a team.

+ Strong attention to details.

+ Ability to establish and maintain effective working relationships.

+ Knowledge of hospital and physician revenue cycle methodology.

+ Knowledge of hospital information systems, including Epic.

+ Knowledge of business analytical practices and methodologies.

+ Knowledge of Microsoft Office software, including strong knowledge of Excel.

Licenses and Certifications

+ RPH - Registered Pharmacist required

+ CPC preferred

+ CCS - Certified Coding Specialist preferred

These principles apply to ALL employees:

SHC Commitment to Providing an Exceptional Patient & Family Experience

_Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery._

_You will do this by executing against our three experience pillars, from the patient and family’s perspective:_

+ Know Me: Anticipate my needs and status to deliver effective care

+ Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health

+ Coordinate for Me: Own the complexity of my care through coordination

Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in** **all of** **its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.

Base Pay Scale: Generally starting at $76.90 - $101.91 per hour

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.

At Stanford Health Care, we seek to provide patients with the very best in diagnosis and treatment, with outstanding quality, compassion and coordination. With an unmatched track record of scientific discovery, technological innovation and translational medicine, Stanford Medicine physicians are pioneering leading edge therapies today that will change the way health care is delivered tomorrow.

As part of our spirit of discovery, we also leverage our deep relationships with luminary Silicon Valley companies to develop new ways to deliver preeminent patient care.

Learn about our awards (https://stanfordhealthcare.org/about-us/awards.html) and significant events (https://stanfordhealthcare.org/about-us/our-history.html) .