UCSD Layoff from Career Appointment: Apply by 04/25/2017 for consideration with preference for rehire. All layoff applicants should contact their Employment Advisor. Eligible Disability Counseling and Consulting services (DCC) or Special Selection clients should contact their Vocational Rehabilitation Counselor for assistance.
Reporting to the Associate Chief of Outpatient Pharmacies, the Reimbursement Analyst is responsible for ensuring the medical center receives appropriate reimbursements for services and products rendered. The Reimbursement Analyst coordinates and supports institutional efforts to maximize reimbursement for drug therapy and pharmacy related services as directed.
The position is part of an interdisciplinary partnership effort with the health system and requires interaction with hospital staff, patients, and payers both proactively and retrospectively. Position objectives include removal of reimbursement as a barrier for optimally effective drug therapy, maximizing institutional revenue, and assistance with other pharmacy operational activities as directed. The Analyst completes routine audits and transaction testing to ensure regulatory billing compliance, and to support departmental compliance initiatives.
Incumbent is a subject matter expert on commercial pharmacy, major medical, government insurance plans, prior authorizations, appeals, and alternate coverage referrals. Position acts as lead for AmCare billing team and project manager for retail pharmacy IT-related development and implementation projects. Incumbent must consistently build and maintain collaborative relationships with other team members within the pharmacy department to ensure a seamless customer experience for patients and physicians. Incumbent also ensures compliance and adherence with all corporate, divisional, and departmental policies and procedures, pharmacy law, and HIPAA guidelines. Generally work is self-directed and not prescribed. Works with less structured, more complex issues. The position is responsible for approximately $40 million of gross retail pharmacy revenue.
Two (2) years reimbursement and/or budgeting experience in pharmacy operations or a large, complex healthcare environment, with financial analysis and billing in all key channels including commercial pharmacy, major medical, and governmental programs.
Graduation from college with a major in business administration, economics, statistics, educational administration, political science, or an allied field, or an equivalent combination of education and experience.
Knowledge of applicable regulations and standards, including HIPAA, Fraud and Abuse, and Pharmacy Law.
Proficiency with Microsoft Office: Word, Excel and Outlook, relational databases, data warehouses, and statistical modeling.
Strong organizational, time management, mathematical, and analytical skills.
Retail pharmacy experience.
Three (3)+ years healthcare industry experience, with knowledge in reimbursement, billing, prior authorization, and appeals.
Medical Office Administration, Pharmacy Technician, Social Services, or similar vocations generally obtained through completion of Associate's Degree, Pharmacy Certification, or equivalent combination of experience and education.
Working knowledge of Quickbooks.
- Must be willing to work various hours and locations based on business needs.
UC San Diego Health is the only academic health system in the San Diego region, providing leading-edge care in patient care, biomedical research, education, and community service. Our facilities include two university hospitals, a National Cancer Institute-designated Comprehensive Cancer Center, Shiley Eye Institute, Sulpizio Cardiovascular Center, and several outpatient clinics. UC San Diego Medical Center in Hillcrest is a designated Level I Trauma Center and has the only Burn Center in the county. U.S. News and World Report’s annual "America’s Best Hospitals" report has repeatedly ranked UC San Diego Health as the #1 health system in San Diego. We invite you to join our dynamic team!
Applications/Resumes are accepted for current job openings only. For full consideration on any job, applications must be received prior to the initial closing date. If a job has an extended deadline, applications/resumes will be considered during the extension period; however, a job may be filled before the extended date is reached.
UC San Diego Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity or sexual orientation. For the complete University of California nondiscrimination and affirmative action policy see: http://www-hr.ucsd.edu/saa/nondiscr.html