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Memorial Hermann Health System

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Pharmacy

Manager, Reimbursement-Specialty Pharmacy

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Location 21501 Park Row Drive,Katy,TX 77449 Facility Specialty Pharmacy Category Pharmacy Type Full time Requisition 100084488

At Memorial Hermann, we’re about creating exceptional experiences for both our patients and our employees. Our goal is to provide opportunities for our diverse employee population that develop and grow careers in a team-oriented environment focused on patient care.

Every employee, at every level, begins their journey at Memorial Hermann learning about the history of the organization and its established culture built on trust and integrity. Our employees drive this culture, and we want you to be a part of it.

Job Summary

The Reimbursement Manager is responsible for leading and implementing strategic and tactical reimbursement activities within the areas of benefit verification, billing activities, payment applications, and collections. Responsible for overseeing the day to day operations of the reimbursement department. Manages and develops reimbursement teams and coordinates activities of team members. Interacts with payers, physicians, case managers, and departments within the pharmacy and health system. Will be responsible in assuring that team supports specialty pharmacy operations and provides quality customer service all within compliance standards.

The Reimbursement Manager reports to the Director of Specialty Pharmacy.

Job Description

Minimum Qualifications

Education:  Bachelors degree in Finance, Accounting or Business related field

Licenses/Certifications:(None)

Experience / Knowledge / Skills:

  • Three (3) years of healthcare revenue, administrative management and/or patient financial services
  • Two (2) years of supervisory experience preferred
  • Previous experience in patient access, billing account resolution, denial management, collections, cash posting, and/ or self-pay collections
  • Specialty Pharmacy experience preferred
  • Knowledgeable and compliant with all relevant laws, rules regulations and accreditation standards and requirement
  • Strong analytical and problem solving skills
  • Excellent communications and customer service skills
  • Ability to build relationships and work effectively at all levels of an organization and to interact confidently with senior management
  • Ability to work within time constraints and deadlines and be able to prioritize multiple tasks
  • Demonstrated proficiency in data entry skills, able to navigate Windows based applications and proficient with accounting, billing and spreadsheet
  • Demonstrates commitment to the Partners-in-Caring process by integrating our culture in all internal and external customer interactions; delivers on our brand promise of “we advance health” through innovation, accountability, empowerment, collaboration, compassion and results while ensuring One Memorial Hermann.

Principal Accountabilities

  • Oversees all activities of reimbursement functions, day to day operations of fast paced customer service area and meeting customer service expectations ensuring all applicable laws and regulations governing debt collections are being met, and ensures that staff meets or exceeds standards of proficiency and professionalism.
  • Builds and motivates reimbursement team with expertise in benefits investigation, billing, accounts receivable and payment processing from public and private insurance companies. Develops, implements, and improves reimbursement strategies, policies, and work plans that optimize performance and minimize expense.
  • Oversees payment processing and adjustments from public and private insurance companies in addition to overseeing the reimbursement software, payor audits, credits, overpayments, and processing of refunds in a timely manner.
  • Reviews and resolves escalated issues with calculations of payment arrangements and settlements on accounts.
  • Demonstrates knowledge based competencies of all insurance billing standards and regulatory guidelines and requirements as it relates to billing.
  • Interacts with external stakeholders or responsible parties to identify reasons for non-payment, identifies and creates a positive plan of action to resolve the account.
  • Serves as a resource for forecasting and annual budgets, prepare interim and annual cost reports.
  • Develops process and procedures that enhance excellent customer service and promote employee satisfaction.
  • Conducts performance counseling and coaching on a periodic basis with team members; conduct performance reviews; make recommendations for salary changes; schedule employees appropriately to make sure department operations hours are properly covered; maintain time and attendance and approve time in accordance with policies.
  • Interacts with all staff levels to insure resolution of client issues, account discrepancies and grievances. Communicates, collaborate and cooperate with internal and external stakeholders as needed.
  • Complies with HIPAA/HITECH Regulations.
  • Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
  • Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.
  • Other duties as assigned.

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