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Specialty Pharmacy Billing Coordinator

Yale New Haven Health
remote work
United States, Connecticut, New Haven
20 York Street (Show on map)
Mar 17, 2025
Overview To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day. Reports to the Sr Manager, SBO Finance, with responsibility for leading all aspects of the Specialty Pharmacy Med B billing staff, their operational workflows, and accounts receivable oversight. Ensures that staff is prepared to perform job functions using a variety of interrelated computer systems. Provides leadership support and staff development through analyzing and identifying trends associated with problem areas within the pharmacy workflows and the full revenue cycle. Ensures that staff use proper escalation procedures both internally and externally after exhausting all avenues for timely resolution of accounts. Develops and implements departmental procedures in conjunction with management to improve workflows and provides recommendations for revenue cycle process improvements. Identifies and implements process improvements related to these functions. Performs quality assurance on accounts to ensure that procedures are adhered to and evaluates the effectiveness of the current system and operational practices. EEO/AA/Disability/Veteran Responsibilities 1. Responsible for coordinating and leading the team. Motivates and inspires team members to achieve goals through effective coaching and mentoring. Supports teamwork and communication among all to foster a work environment conducive to collaboration, brain storming, problem solving, risk mitigation and accountability 2. Ensures staff uses proper escalation procedures both internally and externally after exhausting all avenues for timely resolution of accounts. Provides feedback and instruction regarding clear and concise documentation of account activity. 3. Monitors employee workflows on the various systems and provides feedback regarding effectiveness of staff to management. Works closely with management and staff to address workflow issues and concerns. 4. Assists the Medicare Part B Billing Analyst teams direct manager/supervisor with engaging Med B billing analyst I and II in projects and initiatives to develop them and give them an opportunity to advance in the career ladder. 5. Participates in the implementation process of all new computer systems, new releases, and any other system enhancements throughout the patient account departments. Serves as a resource on the various system application fundamentals for specialty pharmacy billing and accounts receivable. Develops instructions, manuals and related operational written documentation for all specialty pharmacy billing and A/R workflows. 6. Researches and stays informed of all audit activities and requirements at the national and local level and provides updates to operational leaders and senior management of any Medicare changes in medication coverage, accepted diagnosis codes, and policies and procedures. 7. Monitors the CMS, other regulatory agencies, and all receivable vendor websites for any updates to ensure that our accounts are compliant with Federal and State requirements. 8. Maintains and adds to personal knowledge by keeping informed of billing and coverage policy updates to regulations and procedural changes. 9. Monitors processes with external agents or vendors. Identifies and implements process improvements related to these functions and communicates with leadership to resolve identified issues and develop enhancements. 10. Works closely with all areas within the Specialty Pharmacy to identify and catalogue opportunities to improve revenue cycle efficiency. Develops QA feedback for process optimization. 11. Participates in the interview process and selection of personnel. Provides input and participates in the actual presentation of performance reviews. Utilizes Kronos to review, edit and authorize the accuracy of employee's hours. 12. Adheres to Yale New Haven Health Standards of Professional Behavior: Patient-Centered Care, Respect, Compassion, Integrity, and Accountability. Always exhibits Outstanding Standards of Professional Behavior and is a role model. 13. Attends meetings and seminars to effectively perform assigned duties. Continue to develop leadership skill through various forums such as the IFE. 14. Participates in Steering Committee projects and presentations 15. Supports management in their efforts and performs all other duties as requested to maintain a smooth operation of the individual departments and contributes to overall group goals. Qualifications EDUCATION Associates degree preferred OR equivalent experience required. PTCB Certified Pharmacy Technician (CPhT) Certification required. EXPERIENCE Three (3) to five (5) years of experience in a Specialty Pharmacy revenue cycle electronic accounts receivable environment, including Medicare billing and regulations. Experience should include extensive computer skills, training and resolving complex issues regarding healthcare coverage. LICENSURE Must have active Connecticut Pharmacy Technician License. SPECIAL SKILLS Excellent interpersonal, analytical, organizational and communication (oral and written) skills. Extensive computer skills and ability to utilize software programs to monitor activity and develop statistical reports for purposes of tracking quality assurance. Extensive knowledge of third-party insurance carriers and their billing and eligibility platforms. Ability to interpret guidelines established by health care industry and government agencies. Strong teamwork and interpersonal skills at all management levels. PHYSICAL DEMAND Office position, located in Hamden, full time weekday position. May also involve remote work (from home or alternative office site). YNHHS Requisition ID 144309