Diplomat Specialty Pharmacy LLC

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Director Specialty Billing

at Diplomat Specialty Pharmacy LLC

Posted: 3/15/2020
Job Status: Full Time
Job Reference #: 021727e0-63cf-4335-913a-4173c7b8a288
Keywords: billing, compliance

Job Description

About Diplomat Pharmacy:
Diplomat Pharmacy, Inc. is the nation’s largest independent provider of specialty pharmacy services- helping patients and providers in all 50 states.  We build solutions for today’s issues while laying the groundwork for tomorrow’s healthcare.  Rooted in specialty pharmacy, our brands harness innovation to create a healthier world. These include:

  • Diplomat Specialty Infusion Group: Our specialty infusion services deliver treatments nationwide, but a high-touch approach makes our care personal.
  • Diplomat Specialty Pharmacy: We help patients across the country face complex and often rare conditions.
  • CastiaRx: The industry’s leading specialty benefit manager, combining full-service pharmacy benefit manager capabilities with deep specialty expertise.
  • EnvoyHealth:  EnvoyHealth is a full-service healthcare solutions company using innovation and technology to help partners improve lives.

Headquartered in Flint, Michigan, we are more than 2,000 professionals working together nationwide to help patients realize health, happiness, and longer, fuller lives.


We are excited to announce that Diplomat, CastiaRx and EnvoyHealth are now part of the Optum family!


What We Offer:
Diplomat understands that high quality people are required to deliver high quality care and services to our patients and customers.  We combine a strong culture with meaningful work.  Being part of a patient’s care team is challenging, important, and rewarding. Diplomat needs strong, effective talent to lead our employees in a fast-paced and dynamic environment that fosters team work, learning, and career growth. At Diplomat, we encourage our employees to continuously learn through our internal Diplomat University classes as well as our Organizational Development team that offers leadership training and development. Listed below are some of the other benefits enjoyed by our team:

  • Matching 401K – 100% vested on the day you sign up!
  • Excellent Medical, Life, Dental & Vision Insurance
  • Short and long term disability Insurance
  • 9 Paid Holidays
  • Minimum of 3 weeks PTO
  • Award- winning wellness programs


Summary: The Director of Specialty Billing will direct, oversee and maintain all division billing functions to create and maintain efficient, accurate and standardized processes for revenue recognition.  They will resolve billing problems that may include but not be limited to billing team structure, payer contractual issues, invoice rejections, timely filing, billing errors, etc.  They will organize the department to maximize production and quality including the design and implementation of daily, weekly and monthly metrics for department management monitoring and oversight.  Interdepartmental communications with Admissions and Collections managers will be key to the success of the role.


Education/Experience: Bachelor's degree and 6 years billing experience required or in lieu of a degree, a high school diploma or GED at least 10 years of billing experience. 5 years’ experience in a management or supervisory role required. At least 5 years specific knowledge and experience in home infusion/specialty infusion billing preferred. 


Duties and Responsibilities include the following.  Other duties may be assigned.

  1. Oversight of all divisional Billing staff.
  2. Design, implement and enforce standardized policies and procedures for the billing process.
  3. Actively evaluate existing and new processes for efficiency and streamlining opportunities.
  4. Ensure all billing is accurate and timely.
  5. Ensure billing compliance with a variety of auditors, regulatory agencies and payers such as various Medicare and Medicaid intermediaries and plans.
  6. Ensure organizational goals and objectives are met.
  7. Manage the integrity, quality, accuracy and performance of the Billing Department.
  8. Systematically monitor the production and output of the billing function using predefined metrics
  9. Design, create and publish a weekly/monthly management report of metrics to show billing volume and trends at the individual, team and department levels
  10. Be proactive in cross training teams to cover individual absences for vacations, illness and turnover.
  11. Communicate and coordinate with Intake, Admissions and Collections personnel regarding insurance benefit verification, authorizations and coding/filing issues.
  12. Communicate with Payer Strategies to resolve all on-going payer issues related to billing
  13. Receives and responds to patient/client questions or complaints regarding billing activities.
  14. Participates as necessary in care conferences and meetings related to DSIG patients.
  15. Engages in management activities with DSIG leadership to establish processes that enable us to continue to grow and meet new challenges.
  16. Communicate with other Reimbursement Managers to ensure accuracy and timely entry of data. 
  17. Play and active role in integration of billing activities throughout the organization as needed.
  1. Other duties as assigned.



To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.


Supervisory Responsibilities:

Directly supervises supervisors/managers division-wide for the billing function. Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.


Language Ability:

Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.


Math Ability:

Ability to comprehend and apply principles of basic math while analyzing data and generating reports.   


Reasoning Ability:

Ability to apply principles of logical thinking to a wide range of intellectual and practical problems.


Computer Skills:

To perform this job successfully, an individual should have knowledge of Microsoft products.


Information Security Expectations:

While performing the duties of this job, the employee is required to abide by Diplomat’s information security policies, employee handbook and security and privacy regulatory requirements. Each employee is responsible for the secure and appropriate handling of Diplomat information, information received by customers, other companies and/or external parties.


Knowledge, Skills and Other Abilities:

  • Time management
  • Oral and written communication skills
  • Professionalism
  • Communication skills
  • Organization
  • Customer Service
  • Detailed
  • Multi-tasking skills
  • Ability to work well with various personalities and within a team
  • Participate in continuous quality improvement activities


Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to walk; sit and use hands. The employee is occasionally required to stand.


Equal Employment Opportunity and Affirmative Action: Diplomat provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Diplomat complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.