Job Type
Full-time
Description
POSITION SUMMARY The Pharmacy & Vaccine Program Financial Operations Director is responsible for financial operational support, reimbursement reconciliation, reporting, revenue cycle coordination, and vaccine program administration for The Wright Center Pharmacy and associated vaccine programs (VaxCare). This position serves as the liaison between Pharmacy Operations, Clinical Operations, Finance, Revenue Cycle, Director 340B Program, third-party payers, third-party administrators (TPAs) and vaccine program vendors to ensure accurate reimbursement, claim routing, payment reconciliation, financial reporting, and operational support.
The position focuses on pharmacy reimbursement analysis, payment reconciliation, third-party accounts receivable monitoring, financial reporting, vaccine program administration, and coordination of vaccine billing workflows.
The Director works collaboratively across departments to improve operational efficiency, support internal controls, maintain accurate financial records, and ensure the integrity of pharmacy and vaccine program data.
REPORTING RELATIONSHIPS The position reports to the Vice President, Controller Revenue Cycle. No staff report directly to this position.
ESSENTIAL JOB DUTIES AND FUNCTIONS While living and demonstrating our Core Values, the
Pharmacy & Vaccine Program Financial Operations Director will:
Pharmacy Financial Operations - Reconcile billing transactions for retail in-house, specialty, and contract pharmacy services.
- Reconcile third-party pharmacy remittances, EFTs, and payment activity to prescription dispensing records.
- Research and resolve unapplied, unresolved, and exception-based payment activity.
- Coordinate with pharmacy personnel, PioneerRX and ProviderPay to resolve reimbursement discrepancies.
- Monitor pharmacy third-party accounts receivable aging and investigate outstanding reimbursement balances.
- Maintain payer enrollment records, EFT information, ERA relationships, BIN/PCN records, and related payer documentation.
- Assist Finance with month-end close processes related to pharmacy operations.
- Perform monthly reconciliation of pharmacy revenues, expenses, inventory, retail claims and 340B savings.
- Review reimbursement trends and identify underpayments, payment variances, and operational trends, and communicate findings and recommendations to leadership.
- Generate recurring and ad hoc financial, reimbursement, utilization, operational reports and dashboards from PioneerRx and related systems.
- Assist with maintenance of pharmacy-related financial policies, procedures, and internal controls.
- Support annual audit requests and financial reporting requirements involving pharmacy operations.
- Serve as a liaison between Pharmacy Operations, Finance, Revenue Cycle, third-party payers, and pharmacy vendors to support reimbursement, payment reconciliation, reporting, and operational support activities.
- Assist with implementation of upcoming 340B Rebate (Pilot) model.
Vaccine Billing Operations- Generate and review daily VaxCare transaction reports to identify vaccine-related claims requiring billing review and follow-up.
- Review vaccine claim activity and determine whether claims are the responsibility of VaxCare or The Wright Center based on established program guidelines and payer requirements.
- Coordinate and maintain vaccine-related billing hold workflows within Medent and other applicable systems until billing responsibility is verified.
- Identify and track Partner Claims requiring submission through The Wright Center's billing processes and coordinate with Revenue Cycle staff to ensure timely billing and reimbursement.
- Research and resolve vaccine billing exceptions, discrepancies, and claim classification issues in collaboration with Revenue Cycle, Clinical Operations, Pharmacy, and VaxCare representatives.
- Maintain supporting documentation and audit trails related to vaccine billing determinations, billing holds, and reimbursement activity.
- Monitor pending vaccine claims and ensure timely follow-up and resolution of outstanding billing responsibility determinations.
- Generate and maintain reports related to vaccine billing activity, claim routing, reimbursement status, and operational performance metrics.
Operational Improvement & Support- Collaborate with Pharmacy Operations, Revenue Cycle, Clinical Operations, and Finance leadership to improve workflows and controls.
- Identify process improvement opportunities related to reimbursement, reconciliation, reporting, and financial operations.
- Develop and maintain standard operating procedures related to assigned responsibilities.
- Participate in special projects and other duties as assigned.
Requirements
- Meet The Wright Center for Community Health and its affiliated entity The Wright Center for Graduate Medical Education EOS© People Analyzer Tool
- Buy in and experience working in the EOS® model (strongly preferred)
- Mission-oriented; represents the enterprise in a professional manner while demonstrating organizational pride
- Associate's or Bachelor's degree in Accounting, Finance, Business Administration, Healthcare Administration, or equivalent experience required.
- Minimum two years of experience in healthcare billing, pharmacy finance, revenue cycle, accounting support, reimbursement analysis, or related financial operations.
- Strong understanding of accounting principles, Experience reconciling financial transactions and researching payment discrepancies.
- Strong analytical and critical thinking skills.
- Strong organizational skills with ability to manage multiple priorities and meet deadlines.
- Advanced attention to detail.
- Excellent verbal and written communication skills.
- Strong Microsoft Excel proficiency.
- Experience working with financial reporting systems, pharmacy billing systems and healthcare reimbursement data.
PREFERRED QUALIFICATIONS - Minimum one to two years of pharmacy experience
- Experience with pharmacy management systems ( e.g., PioneerRx, ProviderPay)
- Experience with vaccine program administration.
- Accounts receivable reconciliation experience
- Healthcare reimbursement analysis experience
