Tennessee Oncology, one of the nation’s largest, community-based cancer care specialists, is home to one of the leading clinical trial networks in the country. Established 1976 in Nashville, Tennessee Oncology’s mission remains unchanged: To provide access to high-quality cancer care and the expertise of clinical research for all patients, at convenient locations within their community and close to their home. Our growing network of physicians and locations is based on this mission. Tennessee Oncology is committed to advancing both the science of detection and targeted treatments, and to making these advances available to every patient. We believe caring for cancer patients is a privilege.
Why Join Us? We are looking for talented and highly-motivated individuals who demonstrate a natural desire to support the meaningful work of community oncologists and the patients we serve.
The Director of Pharmacy Business Management is responsible for the day-to-day oversight of patient advocates, billing, contracts, credentialing and analytics for Park Pharmacy (PP). This position will provide oversite of daily operations and workflows, will monitor Key Performance Indicators (KPI) and trends, and direct work to mitigate issues. This role will work closely with the SVP of Pharmacy Services and SVP of Revenue Cycle Management to plan and coordinate the strategic initiatives of Park Pharmacy and will prioritize and escalate issues as needed. Collaboration with other departments, executive leadership and involvement with multi-departmental projects is essential.
ESSENTIAL FUNCTIONS:
- Oversees management of the Business team setting benchmarks and measuring performance. Oversight includes Patient Advocates (Prior Authorization and Copay Assistance), Billing, and Contracting (including PBMs), Credentialing, and Analytics.
- Maintain Pharmacy Credentialing with NCPDP, PSAO, vendors, contracted entities, accrediting bodies, etc.
- Working knowledge of Business of Oncology (i.e. PBMs). Meet with industry representatives to maintain knowledge of new products coming to market as well as reimbursement and regulatory changes.
- Knowledgeable of payer policies, coverage requirements, and billing-related regulatory requirements reporting new trends to leadership and managers.
- Oversee the economics of assigned script considering insurance coverage, out of pocket cost, assistance options and Park Pharmacy’s financial policies.
- Evaluate profit margins and consider multiple factors to evaluate profit/loss margin and make recommendations accordingly.
- Responsible for reviewing and trending KPIs and reporting any variances to the SVP of Pharmacy and CEO monthly with explanation.
- Maintain relationships with key payer groups to resolve escalated payment issues.
- Work collaboratively with SVP of Revenue Cycle Management and with other members of the leadership team.
- Prepare monthly reports for SVP of Pharmacy and CEO detailing Park Pharmacy performance and projecting forward losses or gains based on industry changes or global payer issues, including evaluation and tracking of DIR fee trends, etc.
- Oversees personnel decisions for business team members including hiring and disciplinary actions. Work with SVP of Pharmacy on departmental budgets, salaries and position control.
- Interface with physicians as needed regarding credentialing, billing, authorization or any other revenue cycle related issue.
- Responsible for annual evaluations and counseling and/or disciplinary processes/corrective action.
- Assures successful realization of goals, implementation and sustainment of projects and initiatives to optimize workflow efficiencies, ensure patient care/satisfaction and regulatory standards are met.
- Identify training needs and correlate resources for teams.
- Lead and conduct routine staff and leadership meetings.
- Miscellaneous duties as assigned requested and/or required.
KNOWLEDGE, SKILLS & ABILITIES:
- Ability to communicate well with all levels of the organization including Executive Leadership and Physicians
- Knowledge of ICD10, CPT and HCPCS coding, certification Preferred
- Excellent knowledge of Microsoft products including Excel, Word, PowerPoint and Access
- Ability to multi-task and oversee multiple projects simultaneously
- Knowledge of OncoEMR and Centricity a plus
EDUCATION & EXPERIENCE:
- Doctorate of Pharmacy degree or equivalent OR
- Bachelors or Masters Pharmacy Administration, JD or MBA with 5 years in pharmacy administration.
- Minimum of 5 years in the HealthCare Industry in a large physician office, retail or hospital setting
- Minimum of 1 year of Management Experience
- Oncology Experience is preferred