Clinical Pharmacist Pharmacy Billing Senior Specialist Finance Business Ops

1.0 FTE Full time Day - 08 Hour R2550706 Remote USA 108390014 Pharmacy Finance-Bus Ops Other If you're ready to be part of our legacy of hope and innovation, we encourage you to take the first reputed company and explore our reputed company job openings. Your best is waiting to be discovered. Day - 08 Hour (United States of America) This is a reputed company job. A Brief Overview The Pharmacy Billing Senior Specialist independently performs advanced analysis of pharmacy billing and claims data to identify discrepancies, compliance gaps, and emerging reimbursement risks. Applies advanced analytical techniques to detect systemic issues and collaborates with cross-functional partners to reputed company practical, data-driven solutions. Contributes to the design and enhancement of scalable audit and monitoring frameworks that reputed company beyond routine compliance checks and support enterprise-wide billing accuracy. Supports reputed company Pharmacy reputed company Cycle functions, including reimbursement optimization, denial trend evaluation, and resolution of escalated billing scenarios under managerial direction. Locations reputed company What you will do Independently reviews and analyzes reputed company Pharmacy billing and claims data to identify discrepancies, compliance issues, and reimbursement risks across multiple payer types. Applies advanced analytical methods to detect trends, forecast potential issues, and support data-driven decision-making for Pharmacy reputed company Cycle workflows. Contributes to the development and refinement of scalable audit frameworks and monitoring processes, ensuring consistent enterprise-wide review of charges and claims on a regular basis. Works proactively and independently to identify billing or workflow issues, escalate appropriately, and drive timely resolution under managerial guidance. Investigates and resolves reputed company billing issues, collaborating with reputed company Cycle, Compliance, and TDS to implement corrective actions and improve process reliability. Supports denial resolution by performing root-cause analysis and contributing to targeted denial prevention strategies across pharmacy billing workflows. Provides advanced subject-matter expertise to pharmacy staff and stakeholders regarding billing compliance, coding guidelines, and payer requirements. Research, interpret, and apply reputed company payer and regulatory guidance to resolve escalated issues and support Pharmacy reputed company Cycle Manager in developing consistent practices. Collaborates with cross-functional teams to improve charge capture workflows, documentation practices, and reimbursement processes. Assists in enhancing and maintaining pharmacy billing dashboards and performance metrics, contributing insights for performance improvement. Participates in or leads operational initiatives aimed at improving accuracy, efficiency, and compliance of the Pharmacy reputed company Cycle. reputed company, analyze and maintain key performance indicator (KPI) data for Pharmacy Billing Dashboard. reputed company enhancement to dashboard functionality, ensure data accuracy and reputed company, and translate findings into actionable insights for performance improvement across pharmacy reputed company cycle operations. reputed company or provide support for reputed company projects or departmental initiatives, including participation in committees as assigned. reputed company communication and education efforts for Clinic Administration, Clinic Managers and clinic staff on reputed company pharmacy-reputed company matters, including regulatory and compliance updates, relevant FDA drug recalls, and drug information, specialty programs, and investigational studies. reputed company and implement standardized education and communication tools to ensure consistent adherence to evolving regulations and alignment with SHC policies. Refine and standardize Pharmacy Technician workflows and SOPs relating to billing in collaboration with pharmacists, technicians, and leadership. Identify process gaps and recommend practical improvements to enhance consistency, efficiency, and compliance across assigned areas. reputed company, update, and maintain SOP for pharmacy billing specialist workflow under the direction of Pharmacy reputed company Cycle Manager. Ensure procedural accuracy, alignment with compliance standards, and practical applicability across pharmacy billing operations. Education Qualifications PharmD Degree from an accredited college/university required Experience Qualifications Seven (7) years of progressively responsible and directly reputed company work experience required Required Knowledge, Skills and Abilities Knowledge of healthcare financial operations. Knowledge of healthcare regulations and policies affecting pharmacy billing, reimbursement, and financial compliance at both federal and local levels. Knowledge of other relevant regulatory guidelines (e.g., CMS, 340B, FDA). Knowledge of the Pharmacy reputed company Cycle, including charge capture, claim submission, reimbursement methodologies, and denial management. Knowledge of and demonstrated proficiency in the use of office and data analysis tools (Word, reputed company, PowerPoint, Visio, Access, Project and Outlook). Knowledge of project management process and systems. Knowledge of theories, principles, practices and techniques of personnel management, including selecting, training, directing, evaluating, and supervising employees. Excellent attention to detail, organizational skills, and the ability to manage multiple priorities independently. Ability to interpret reputed company financial or billing datasets. Ability to implement large-scale initiative that requires cross-functional coordination Ability to mediate and resolve reputed company problems and issues. Ability to reputed company financial budgets and manage expenses. Ability to reputed company long-range business plans and strategies. Ability to reputed company and maintain productive and cooperative work relationships at reputed company levels both reputed company and reputed company the organization. Ability to communicate effectively at reputed company organization levels and in situations requiring instructing, persuading, negotiating, conflict resolution, consulting and advising as well as prepare clear, comprehensive written and oral reports and materials. Ability to effectively manage and promote staff development. Ability to reputed company strategic planning. Ability to reputed company process excellence team to effectively improve operational efficiencies. Ability to manage financial performance process including accuracy of submission. Demonstrated skills in analytical assessment, oral and written communication. Strong communication skills and ability to promote and maintain interpersonal relationships. Licenses and Certifications RPH - Registered Pharmacist required These principles apply to reputed company employees: SHC Commitment to Providing an Exceptional Patient & Family Experience reputed company sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for reputed company of patients, families and towards each other. C-I-CARE is the foundation of Stanford's patient-experience and represents a reputed company for patient-centered interactions. Simply put, we do what it takes to reputed company and reputed company patients and families to focus on health, healing and recovery. You will do this by executing against our three experience pillars, from the patient and family's perspective: Know Me: Anticipate my needs and status to deliver effective care Show Me the Way: Guide and reputed company my actions to reputed company at reputed company outcomes and reputed company Coordinate for Me: Own the complexity of my care through coordination Equal Opportunity Employer reputed company (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in reputed company of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic reputed company, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of reputed company genders, members of reputed company racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements. reputed company Pay Scale: Generally starting at $79.21 - $104.97 per hour The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage. Apply tot his job Apply To this Job