Provider Contracting Director jobs in West Virginia

The primary focus of the position is to support the operational efficiency of the Pharmacy Department by coordinating fiscal management activities, performing data analysis and maintaining departmental statistics and reports. Data base development, project management, cost accounting, and IT skills will be employed to work with clinical pharmacists, residents, medical staff, and pharmacy administration.

MINIMUM QUALIFICATIONS:
EDUCATION, EXPERIENCE, CERTIFICATION, AND/OR LICENSURE:
1. Bachelor degree in Information Technology, Business Management, Hospital Administration, Accounting, or Finance and two (2) years of experience in pharmacy or one (1) year of experience with financial reporting
OR
Associates degree in Information Technology, Business Management, Hospital Administration, Accounting, or Finance and Four (4) years of experience in pharmacy or Three (3) year of experience with financial reporting
OR
High School Diploma and Nationally Certified Pharmacy Technician within 15 months of hire and Seven (7) years’ experience in a healthcare setting

PREFERRED QUALIFICATIONS:
EXPERIENCE:
1. Direct experience in data analysis and/or health care planning background preferred.
2. Two (2) years of experience in a professional capacity in healthcare, preferably in Pharmacy.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position.  They are not intended to be constructed as an all-inclusive list of all responsibilities and duties.  Other duties may be assigned.

1. Assures that billing procedures performed by the department are accurate and timely.
2. Coordinates with Patient Financial Services to review underpayments or denials.
3. Routinely reviews medications administered that are included on the transitional pass-through list and assures accurate billing procedures are followed.
4. Assures charges governed by APC’s are handled correctly.
5. Facilitates the addition, deletion or correction of charges to the charge master as needed.
6. Maintains all the HCPCS changes and updates for Chargemaster.
7. Assures utilization of all available indigent care programs for inpatient and outpatient Administration of medications.
8. Coordinates with Clinical Specialists to evaluate practice change opportunities that would allow inpatient medication administration to be switched to outpatient medication administration.
9. Evaluates drug inventory levels and makes recommendations to pharmacy manager.
10. Monitors purchases for contract compliance and accurate pricing.
11. Coordinates with Premier (GPO) and Amerisource Bergen to assist with contract compliance and identify savings opportunities that we are not taking advantage of at this time. Relay those items to Pharmacy Manager & Inventory Buyer to implement changes when possible.
12. Monitors monthly budget variance, identifies significant activity.
13. Generates a year-end report of budget versus expended dollars based on reconciliation of budget with the general ledger, for each cost center by account.
14. Compiles data, profiles comparisons and generates reports related to current expenses to serve as the basis for the asking budget.
15. Provides data to support department performance improvement activities related to drug utilization, purchasing, billing and reimbursement.
16. Generates pharmacy spend advisor reports on a monthly basis to ensure that we are purchasing pharmaceuticals in the most cost efficient manner. Communicate those opportunities to Pharmacy Manager & Buyers. Follow up to assist with implementation of changes.
17. Documents expenditure activity by account by cost centers as expenditures are processed and according to accepted accounting practices.
18. Reconciles department current expenditure documentation with the hospital general ledger and rectifies errors within 30 days.
19. Identifies irregular spending and system failures related to current expense activity and reports to department Director.
20. Interacts with hospital purchasing, materials handling and other departments responsively and productively to promote efficient systems interface and problem resolution related to fiscal and clinical management.
21. Interacts regularly with the department management team and clinical specialists to supply drug usage information, identify irregularities in spending, and provide recommendations for alternative products.
22. Supports Pharmacy, Nutrition and Therapeutics Committee functions by providing financial data to be used in the drug evaluation process, including opportunities for therapeutic interchange of medications.
23. Works with department management in the development and implementation of departmental goals and objectives.
24. Participates in the planning and implementing change and maintaining the improving productivity through attendance and participation in staff meetings, committees, task forces and projects.
25. Participates in the education of other health-care professionals as it pertains to appropriate use and billing of medications.
26. Accountable agent for 340B compliance.
27. Responsible for maintenance and testing of tracking software.
28. Responsible for documentation of policy and procedures.
29. Maintain system databases to reflect changes in the drug formulary or product specifications.
30. Assure appropriate safeguards and system integrity.
31. Assure compliance with 340B program requirements of qualified patients, drugs, providers, vendors, payers, and locations.
32. Review and refine 340B cost savings report detailing purchasing and replacement practices, as well as dispensing patterns.
33. Monitor ordering processes, integrating most current pricing from wholesaler, analyze invoices, shipping, and inventory processes.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. While performing the duties of this position, the employee is required to walk and stand for long periods of time. 
2. Must be able to lift 30 pounds and must be able to push 50 pounds.
3. Dexterity required to finger, handle, and reach. 

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

SKILLS AND ABILITIES:
1. Extensive working knowledge of Microsoft Office applications Excel & Access

Additional Job Description:

Scheduled Weekly Hours: 40

Shift:

Exempt/Non-Exempt: United States of America (Exempt)

Company: SYSTEM West Virginia University Health System

Cost Center: 249 SYSTEM Pharmacy Business Operations

Address: 3040 University Ave

Morgantown

West Virginia



WVU Medicine is proud to be an Equal Opportunity employer. We value diversity among our workforce and invite applications from all qualified applicants regardless of race, ethnicity, culture, gender, sexual orientation, sexual identity, gender identity and expression, socioeconomic status, language, national origin, religious affiliation, spiritual practice, age, mental and physical ability/disability or Veteran status.