Baptist Health System KY & IN

• Responsible for routine data extraction, report generation, and variance analysis for defined projects of limited scope • Assists in monitoring key performance indicators and supports the tracking of savings initiatives and contract compliance metrics • Collaborates with Supply Chain colleagues and interfaces with internal customers as directed • Supports team efforts to meet established goals and develops an understanding of how data analysis informs supply chain strategy and operations at Baptist Health • Utilizes data from established sources, under guidance from senior team members, and learns to interpret data within standardized templates and reporting frameworks

• Responsible for CDI query reconciliation accuracy • Compiling and generating key performance metrics for entities such as physicians, providers, CDI team and facility leadership after review with CDI Leadership • Participate on multi-disciplinary enterprise quality and process improvement teams • Collaborate with CDI Auditor/Educators to develop and implement programs for ongoing CDI, physicians, providers, and ancillary departmental education • Evaluate opportunities for new CDI initiatives via ongoing metric analysis including validating workflows, tracking, and trending of results • Perform other duties as assigned

• Provides local oversight of the 340B program. • Utilizes 340B software to maintain program compliance according to OPA. • Ensures that the 340B pharmacy program is continuously compliant with 340B federal regulations. • Develops, executes, and documents self-audits of the 340B process. • Coordinates and ensures remediation of findings. • Reviews and monitors all points of service where 340B participation occurs to ensure policy and procedure compliance, covered entity eligibility, and “covered patient” eligibility. • Responsible for managing and troubleshooting pharmacy billing issues and ensuring that adequate systems checks are reviewed to prevent billing issues. • Evaluates patient eligibility for qualified and non-qualified patients in hospital-based mixed-use areas by reviewing patient medical records, insurance plans, and hospital status. • Serves as the primary internal program coordinator and liaison for all 340B-related matters. • Assesses opportunities for cost savings and process improvements to yield higher compliance. • Collaborates with system and local leadership to improve and enhance service offerings. • Provides oversight for the implementation of process improvement initiatives. • Monitors purchasing records and clearly documents utilization, savings, problem areas, and exceptions or discrepancies. • Monitors inventory levels to effectively balance product availability and cost-efficient inventory control. • Serves as the point person and coordinator for all mock, HRSA, and manufacturer audits. • Maintains a current state of “audit readiness”. • Provides oversight for all audits performed by independent external auditors. • Assists in monitoring reports to ensure compliance with the program.

• The Pharmacy Revenue Cycle Analyst is responsible for ensuring optimal revenue capture for pharmacy services provided at Baptist Health to help maximize financial performance. • Monitor revenue cycle performance by reviewing pharmacy charge capture, correctly capturing and coding pharmacy charges, ensuring accuracy of inpatient and outpatient claims processing and reviewing denials and write-off assessments. • Utilize expertise in coding to ensure efficiency and excellence for patients and providers. • Assist pharmacy leadership in developing and maintaining the payment models for managed care negotiations, payment auditing, and denial management. • Analyze, update, and correct claims data to ensure billing for all inpatient, outpatient commercial, Medicare, Medicaid, MCOs, and community pharmacy PBM accounts is accurate and timely. • Collaborate with accounts receivable through prompt and accurate billing, payment auditing, credits, and follow up of all patient accounts with Medicare, Medicare Advantage, Medicaid, PBMs, and MCOs. • Coordinate with sites, managed care, and the business office to decrease medication-related claim denials, underpayments, and outstanding claims. • Review, investigate, and process high dollar and high dispense quantity work queue items. • Perform quality reviews to ensure that pharmacy charge description master (PCDM) additions, inactivations, changes and/or revisions were accurately completed in the clinical and financial systems. • Assist Baptist Health’s pharmacy contract negotiating team in developing and maintaining up to date, accurate payment models for contract management processes and reporting on current profitability, payor analysis and other key areas of analysis. • Collaborate with clinical staff, other departments, and physician offices to request assistance when necessary to successfully appeal an account. • Ensure appropriate follow ups on accounts until a resolution is reached or all reasonable appeal options are exhausted. • Assist with contract compliance and identify savings opportunities. • Test and implement software upgrades related to payment modeling software with IT and software vendor. • Develop quality metrics and audit methodologies to drive accuracy and first-time quality for all HCPCS/CPT codes, revenue codes, billable units, multipliers, modifiers, and indications. • Assist with the development and enhancement of analytical tools for prospective and retrospective audits and data analysis. • Coordinate the overall maintenance of all pharmacy revenue cycle scorecards, dashboards and key performance indicators. • Audit price file updates from wholesaler, non-wholesaler, Epic, charges, and patient information. • Develop reports to highlight the proposed vs. actual financial impact by contract term. • Provide education to site and system stakeholders to drive optimal revenue capture and compliance. • Assist with development of policies, guidelines, and procedures for pharmaceutical coding, billing, pricing, charging, and denial management. • Participate in committees, work groups, process improvement efforts, and educational initiatives.

• Set strategic direction and lead systemwide Accounts Payable operations • Provide leadership, coaching, and development for the Accounts Payable team • Ensure vendor master data integrity and 1099 compliance • Collaborate with ERP stakeholders to maintain and enhance payables-related systems, controls, metrics, and reporting

• Function in a fully accountable role ensuring the overall quality of inpatient coding • Ensure accurate and complete coding for measuring and reporting outcomes • Maintain up to date knowledge of clinical coding as per guidelines

• Responsible for application and integration of information technology in the healthcare setting • Serve as a liaison between the IT department and operations • Data collection, workflow analysis, system configuration, testing, and support • Participate in application deployment and procedure documentation • Ensure that the software build meets organizational goals and external mandates such as HIPAA and Meaningful Use

• Responsible for application and integration of information technology in the healthcare setting • Serve as a liaison between the IT department and operations • Data collection, workflow analysis, system configuration, testing, and support • Participate in application deployment and procedure documentation • Ensure the software build meets organizational goals and external mandates

• Provide supervision to pharmacists and pharmacy care coordinators embedded in specialty medical practices • Oversee day-to-day specialty pharmacy clinic operations • Support collaboration with the central pharmacy fulfillment team • Assist with the development and implementation of strategic initiatives for specialty pharmacy operations • Monitor key specialty pharmacy performance indicators for continuous improvement • Collaborate with internal medical group personnel to maintain good communication • Complete internal audits of specialty clinical documentation • Partner with leadership to evaluate clinic performance and update budgets

• Uses knowledge of information technology (IT), automation systems and medication-use process to improve patient care by supporting technologies that lead to safer, more cost-effective medication use • Includes automation and technology systems management, management of projects, and training and education • Supports pharmacists, physicians, nurses, and other healthcare team members as the resource for requests related to pharmacy system changes • Works with Manager of Pharmacy Automation and other BH leaders to implement, integrate, and maintain evidence-based and regulatory standards of clinical/operational pharmacy services • Provides onsite professional consultative oversight to the maintenance, upgrading, evaluation, and implementation of pharmacy computer software systems and automation • Supports pharmacy information software applications and pharmacy automation • Manages and leads the pharmacy’s informatics and technology/automation enhancement initiatives • Coordinates and manages the implications of automation and technology associated with the medication use process • Ensures integration, standardization and maintenance of pharmacy technology/automation systems • Analyzes systems and operations involved with medication storage, preparation, and distribution to ensure cost-effective and optimal delivery of medication therapy