This is a strategic financial role for Fairview Pharmacy. In this position you will lead the operations associated with specialized revenue cycle, administration, health plan billing, pharmacy benefit billing, credit, collection, accounts receivable management and reporting for Specialty, Retail and consulting Pharmacy Services businesses of Fairview Pharmacy Services, LLC. Ensure compliance with all regulatory requirements. Develop and implement changes to processes and technology both internally and through specialized vendors for existing and new pharmacy business units. Provide outstanding customer service to internal and external customers, maintaining excellent customer focus. Lead processes, technology and partnerships to create a national scalable platform to deliver industry-leading revenue cycle services for health system-based specialty pharmacies and national for-profit company competition. Build strong relationships with clients and venture partners to assist with the formation and implementation of billing and financial systems. Accountable for over $1.7B and 2.5M claims collections annually. Maintain and improve upon leading performance metrics. Leads changes and improvements using LEAN principles. 

This position is full-time as well as benefit eligible!

• Review, develop and recommend strategies and processes related to billing, collection and accounts receivable activity, while maintaining customer focus and regulatory compliance.
  • Recommend changes in methods or procedures to increase the efficiency of the business office unit.
  • Maintain compliance with regulatory requirements of Medicare (multi-region) and Medical Assistance (multi-state) affecting Pharmacy.
  • Complies with relevant laws, regulations and policies.
  • Assists with the development and implementation of necessary compliance policy and procedures, process improvement methods.
  • Manage and ensure appropriate billing, collections, and AR support with pharmacy operations.
  • Coordinate new processes to ensure appropriate business office support for existing and new business lines
• Assist with the planning, scheduling, and direction of the work for the business office unit within the established policies of the organization.
  • Provide leadership to staff in the accomplishment of goals, projects, and initiatives.
  • Provide direct supervision for assigned staff, complete timely goal setting and performance reviews.
  • Recruit/interview/hire staff. Coordinate orientation of new staff and ensure ongoing education of current staff.
  • Maintain and monitor the productivity level of the staff to maximize efficiency, ensure adequate staffing levels, and control costs.
  • Promote overall employee engagement.
  • Seeks and implements strategies to meet department goals.
  • Identify training needs of business office personnel, develop and coordinate training programs, conduct training where applicable.
• Maintain excellent working relationship with internal and external customers and other Fairview entities.
  • Maintain direct relationship with claim processing and provider relations of major payers.
  • Assist with the management of relationships with external pharmacy business office vendors, including, but not limited to, the outside collection agency, the medical billing clearinghouse, the patient statement processor, and the third party claims reconciliation company.
  • Provide strategic evaluation of AR and financial software systems and implementation of new systems.
  • Provide training and support for business office functions within the software system.
  • Develop and maintain relationships with pharmacy business lines and pharmacy support services teams.
  • Work collaboratively to ensure seamless pharmacy service to complex patients.
  • Work proactively with internal customers to continually implement process improvement initiatives.
• Provide industry expertise and consulting to FPS’ venture partners. Engage with venture partner’s executives or professionals to provide expert insight and feedback on the venture partner’s proposed solutions and products.
  • Develop a clear understanding of the product/service that is being developed with the venture partner and critically analyze to ensure the product/services will provide enhanced value to the revenue cycle workflow.
  • Provide pharmacy revenue cycle insights to venture partner teams to assist with product/service improvements.
  • Collaborate with venture partners on quality assurance testing for minimal viable products and provide recommendations on improvements that would enhance the efficiency, financial gain and accuracy of the pharmacy revenue cycle workflows/processes.
• Assist in the financial management of External Consulting clients’ pharmacy operations.
  • Communicates complex financial information in a clear, concise manner.
  • Present Financial Management support to clients, including receivable management, financial report and contracting support.
  • Provide sales/presentation/assessment/workshop support for external consulting clients.
  • Support various business office information systems development, conversion and implementation tasks.
• Develop and maintain an external revenue stream from consulting and services to Health Systems Specialty Pharmacies nationally.
• Assist with corporate goal setting related to billing, collections, and accounts receivable. Make recommendations or act as necessary.

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 and maintains knowledge of all relevant laws, regulation, policies, procedures and standards.

• Fosters a culture of improvement, efficiency and innovative thinking.
• Performs other duties as assigned.

Required Education

• BS or BA in Business, finance, accounting, pharmacy, or related field

Required Experience

• 10 years’ experience in healthcare or pharmacy business office
• 7 years in a leadership role with previous supervisory/management experience.

Preferred Education

• Advanced Degree; MBA, JD and/or another business-related field.

Preferred Experience

• 15 years of experience in healthcare business office.
• 15 years of experience in Pharmacy or pharmacy plan sponsor environment.
• 5 years of experience working in environments where Lean processes were successfully deployed.
• 10 years in a leadership role with previous supervisory/management experience

License/Certification/Registration

• LEAN process improvement certification
• Certified Public Accountant (CPA)
• Certified Pharmacy Technician (CPhT)
• Pharmacist (RPh)