MedStar Washington Hospital Center

We are actively recruiting for an experienced pharmacy leader to join our team at MedStar Georgetown University Hospital in Washington, DC in the role of Program Manager, Pharmacy Analytics and Billing. The position will primarily be responsible for pharmacy analytics and billing, including but not limited to detailed review of medication use cycle to provide technical support in the design, implementation and ongoing monitoring of pharmaceutical charge and spend as well as workload and quality metrics for performance improvement. These functions are performed in accordance with all applicable laws and regulations and Georgetown University Hospital's philosophy, policies, procedures and standards.

Education

• Bachelor's degree in Business, Informatics, or Engineering required
• Master's degree MBA preferred

Experience

• 5-7 years Experience in finance, performance management and metrics implementation, statistical analysis, visualization, and/or data analysis, preferably in a leadership role. Experience with mathematical process modeling, including discrete event simulation, linear programming, system dynamics, queuing theory and monte carlo simulation required
• 3-4 years Experience in a healthcare environment. 3 years' experience with operational and/or clinical data. experience using statistical computer languages and software (r, python, sql, minitab, etc.) to manipulate data and draw insights from large data sets preferred

Licenses and Certifications

• Lean Six Sigma Black Belt (SIXSIGBB) Upon Hire preferred

Knowledge, Skills, and Abilities

• Critical thinking, reasoning and problem solving.
• Strong interpersonal skills, organizational awareness and communication skills.
• Strong facilitation and presentation skills. Ability to understand business need(s) and conduct appropriate analysis to translate data into actionable insights.
• Advanced skill in MS Excel, MS Access, SQL and Tableau.
• Knowledge of a variety of machine learning techniques (clustering, decision tree learning, artificial neural networks, etc.) and their real-world advantages/drawbacks.
• Knowledge of advanced statistical techniques and concepts (regression, properties of distributions, statistical hypothesis tests and proper usage, etc.) and experience with applications.

Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Complies with governmental and accreditation regulations.

Conducts accurate, meaningful, and actionable analysis to support the needs of stakeholders. Supports stakeholders with ad hoc data and analytics requests.

Designs and develops meaningful and actionable models and dashboards for monitoring operational, financial, quality, productivity and/or clinical performance.

Develops and leads/manages work plans driving accountability and achievement of timeline, meeting all established goals and deadlines.

Effectively escalates and communicates risks and issues, while communicating status updates.

Ensures and responsible for documentation of business requirements, data dictionaries, operational support guides and other relevant documentation to support design, development, governance, and sustainment of dashboards and analytic tools.

Establishes and manages production data and analytics processes and deliverables. Develops and performs QA processes to ensure data accuracy. Troubleshoots issues and errors. Enhances analyses and dashboards as requested. Creates innovative solutions to automate the production of standard reporting and dashboards.

Facilitates/leads business requirements and design sessions.

Identifies appropriate data sources and works with data owners to obtain appropriate data access (via database access, extracts, reports).Partners with stakeholders to ensure data accuracy, develops data definitions, business rules for metric calculations and validation of outputs.

Leads meetings and workgroups with stakeholders to establish common understanding of the opportunity/problem to be measured, customer requirements, and drives work plan progress.

Partners with key stakeholders to understand operational challenges, needs and processes to develop KPIs, dashboards, and effective analytics for measuring, improving and managing performance.

Performs statistical analysis (including hypothesis testing, regression analysis, factor analysis, capability analysis, variance analysis) and articulates interpretation of statistical testing results. Measures performance before and after implementation of a change to measure impact.

Presents analytics to varying audiences, adjusting the presentation of data based on target audience (ranging from senior executives to service line managers to frontline personnel).

Provides education and coaching as needed to ensure stakeholders are able to effectively understand and utilize analyses and dashboards.

Responsible for challenging the status quo by probing and following-up with questions to arrive at sophisticated findings and conclusions. Delivers skillful analysis of complex clinical and operational data. Responsible for driving organizational, prioritization and time management practices.

Responsible for effectively communicating data in graphical, textual, and numerical table formats. Visualize data effectively to tell a story and to guide action.

Use pharmacy health system knowledge to perform detail review and analysis of pharmacy dispense, verification, administration documentation, waste documentation and coding to ensure pharmacy billing compliance standards are met. - Verify medication dosing unit of measure calculation based on specific National Drug Code (NDC) and for units administered to the patients - Ensure current up to date pricing by validating Epic applied pricing is consistent with external source, when inconsistency exist use experience and judgement to propose resolution - Review Healthcare Common Procedure Coding Systems (HCPCS) coding and Medicare billing quantity are appropriate to ensure maximize reimbursement and prevent payer denial - Analyze and validate accuracy of JW Waste Modifier documentation and perform manual calculation and charge when necessary - Trouble shoot, problem solve, communicate and collaborate deficiency - Maintain multiple follow-up and work towards resolution with Nursing, Providers and Pharmacy Operations on deficiency to support billing compliance - Analyze and interpret paper medication documentations for non-EHR system charge and perform manual charge capture aka bulk charging

Provide technical support in the design, implementation and ongoing monitoring of pharmaceutical charges across multiple pharmacy systems. Ensure pharmacy charge methods are in compliance with regulatory requirements.