Pharmacy Revenue Analytics Program Lead - Silver Spring

Required Licenses/Certifications

• Not applicable.

Functional Accountabilities

Revenue Optimization Program Administration

• Develops policies, guidelines, and procedures for pharmacy coding, billing, pricing, charging, and denial management to maximize reimbursement and ensure compliance.
• Conducts PCDM (Pharmacy Charge Description Master) quality reviews for accurate system updates in clinical/financial systems.
• Collaborates with Pharmacy & Therapeutics Committees, Oncology, and Managed Care to align formularies.
• Researches and stays updated on billing and revenue compliance/optimization, advising organizational decisions.
• Works with Finance, Revenue Integrity, Compliance, Decision Support, and other departments to streamline pharmacy revenue processes, billing, and collections.
• Leads pharmacy revenue-related projects and workflow changes, including:
  • Documenting areas of financial risk and workflow impact.
  • Presenting findings to leadership for recommendation approval and implementation.
  • Developing process flows, education, and communications for revenue integrity and compliance.
• Assesses the effectiveness/feasibility of pharmacy initiatives to ensure compliance with regulatory standards and policies.
• Engages in committees, process improvement, and education initiatives tied to pharmacy revenue.
• Acts as the go-to expert on compliance billing and provides education to stakeholders on optimal revenue capture.
• Supports managed care, business offices, and revenue integrity teams to reduce denial claims.
• Coordinates between Finance, Pharmacy, Decision Support, Compliance, and Revenue Integrity to enhance charging/denial workflows.
• Collaborates with pharmacy leadership on reimbursement issues related to 340B operational reporting and access to high-cost therapies.
• Conducts benchmarking research using industry organizations (HFMA, AAHAM) and hospital resources (Vizient, CHA) to assess national/regional pharmacy revenue trends and innovations.

Program Reporting, Analytics & Information Resources Management

• Oversees weekly and monthly Pharmacy Revenue Cycle (RC) dashboards, including data mining and report interpretation.
• Develops analytical tools to audit and optimize billing accuracy for maximal revenue capture.
• Analyzes Pharmacy Revenue KPIs and monitors special impact scenarios (oncology, pharmacy waste, interdepartment chargebacks).
• Participates in financial impact assessments for PCDM maintenance changes.
• Establishes quality metrics and audit methodologies for:
  • Accurate HCPCS/CPT codes.
  • Revenue codes, billable units, multipliers, and modifiers.
• Develops and supports Accounts Receivable (AR) strategy for process improvements.
• Identifies reporting/dashboards enhancements to optimize revenue cycle workflows.
• Actively develops, implements, and maintains data systems supporting Pharmacy Revenue Cycle compliance and efficiency.
• Responds to ad hoc report requests from internal stakeholders promptly and accurately.
• Serves as the "super user" for Pharmacy Revenue Cycle tools, providing critical expertise for system upgrades and enhancements.
• Utilizes IT systems (Business Objects, Avalead) for data analysis, troubleshooting, and process improvement.
• Conducts charge, payment, and denial analysis using analytical tools (Excel, Access).
• Supports Pharmacy Revenue Cycle systems optimization initiatives while ensuring compliance.

Additional Notes & Policy Statements

This salary range reflects the minimum and maximum compensation for the base pay rate within which Children’s National believes the individual will fall. Pay will depend on market conditions, organizational needs, and the candidate’s qualifications.

Children’s National is an equal-opportunity employer and prohibits discrimination based on race, color, religion, sex, age, national origin, disability, veteran status, sexual orientation, gender identity, or other protected characteristics. More details available on the Know Your Rights and Pay Transparency Nondiscrimination Poster.

**Drug-Free Workplace Policy:**
Recoverable and medical marijuana, though legal in the District of Columbia, is prohibited under Children's National and its affiliates' drug-free workplace policy.

Benefits That Support You

• Comprehensive health coverage, including medical, prescription, infertility, and transgender health services.
• Generous paid time off:
  • Vacation accrual from the first day.
  • Sick leave, holidays, and personal days.
• Financial wellness support:
  • 401(k) plan access.
  • Healthcare and dependent care spending accounts.
• Employer-paid life, AD&D, and long-term disability coverage, with optional supplemental plans.
• Additional perks, including:
  • Tuition assistance.
  • Fitness resources.
  • Employee assistance programs.
  • Commuter benefits.

Why Join Us?

• Nationally Recognized Excellence – Consistently ranked among Top 10 Children’s Hospitals by U.S. News & World Report®.
• Leading Pediatric Care – Largest and most comprehensive children’s hospital in the region, specializing in mesothelioma _note: "What if sarcasm/maintained for non-institutional tone?"_and cutting-edge treatments.
• Innovation & Research – Premier academic medical center prioritizing pediatric healthcare innovation, education, and research.
• Mission-Driven Culture – Focused on family-centered care, while supporting a collaborative, inclusive environment for its team.