Reimbursement Specialist - Pharmacy

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.

About Duke University Hospital

Pursue your passion for caring with Duke University Hospital in Durham, North Carolina, which is consistently ranked among the best in the United States and is the number one hospital in North Carolina, according to U.S. News and World Report for 2023-2024. Duke University Hospital is the largest of Duke Health's three hospitals and features 1048 patient beds, 65 operating rooms, as well as comprehensive diagnostic and therapeutic facilities, including a regional emergency/trauma center, an endo-surgery center, and more.

General Description of the Job Class

Compile, analyze and report on the performance of the Department of Pharmacy, noting trends and making recommendations or conclusions regarding progress. 

Duties and Responsibilities of this Level

• Analyze and provide feedback for pharmacy reports.

• Utilizes clinical and coding knowledge to ensure accurate and compliant charge items and to recognize and resolve billing inconsistencies.

• Coordinates projects and audits to improve processes related to revenue cycle, efficiency of charging and billing, and collection efforts.

• Assist management in forecasting by providing historical information. Work with departmental directors, managers and appropriate personnel to ensure budgetary compliance.

• Manage appropriate systems for accounts receivable and/or financial reporting and prepare written reports and analyses for PRMO and DUHS leadership, documenting trends and appropriate recommendations/conclusions.

• Coordinate communication between insurance companies, governmental agencies, providers and support staff.

• Trend and report on departmental performance indicators and goals. Ensure departmental goals are satisfied.

• Make recommendations to improve financial systems; perform in house audits of operating units; analyze deficiencies and report to manager/director.

• Assist in developing and defining short and long term departmental specific goals and objectives.

• May be responsible for managing and delegating database inquiries. Creation and development of work assignments including training of employees.

• Maintain professional relationship with internal and external agencies and professional organizations concerning operations.

• Develop and provide job-specific training to new and existing employees within department.

• Perform other related duties incidental to the work described herein.

Required Qualifications at this Level

Education

High school diploma or equivalent is required, preferably supplemented by post-secondary courses in Accounting, Finance, Economics, Business Administration or a related field.

Experience

Four years of related experience in healthcare is required. A Bachelor's degree in a related field can substitute for the experience requirement.

Knowledge, Skills, and Abilities

Data analysis and reporting Billing/Collections Insurance Claims Microsoft Office (Excel, Access, Word, Powerpoint) Good communication skills (verbal and written) are essential.

Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex (including pregnancy and pregnancy related conditions), sexual orientation or military status.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends onthe robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.

Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.