Pharmacy Reimbursement Division

Purpose Statement

The purpose of the Pharmacy Reimbursement Division (PRD) is to enhance internal stakeholders' pharmacy billing and financial acumen and help optimize the reimbursement for our medications used within our healthcare system affiliates.

Mission Statement

The mission of the division is to assist the health system in maintaining its fiscal responsibility by improving the recovering of medication revenue.

Who We Are

The PRD consists of a team of individuals with expertise in medication billing and reimbursement. The team is led by a Pharmacy Clinical Systems Integration Manager and supported by a Pharmacy Clinical Financial Analyst and a Pharmacy Reimbursement Specialist. All team members have a background in pharmacy either as a pharmacist or pharmacy technician.

How We Accomplish Our Mission

Our team accomplishes our objectives by continuously collaborating with various interdisciplinary departments (pharmacy departments, billing, patient accounting, revenue cycle IT, revenue integrity, finance, managed care and enterprise clinical information systems) to resourcefully seek innovative pharmacy revenue opportunities. We proactively reconcile charges and review Federal, State and Commercial billing regulations while decreasing insurer denials.

Duties/Responsibilities

The PRD operates under the Corporate Pharmacy department. The division's duties and responsibilities are established by affiliate needs as well as system-wide strategies.
  • Reviews, identifies, and help affiliates remedy aberrant medication charges
  • Performs audits post go-live, either operational or clinical in nature to ensure that expected outcomes are met and help mitigate unintended consequences
  • Responds to pharmacy billing inquiries in a timely manner and offers guidance regarding insurance reimbursement
  • Educates affiliates on accurate billing and charge reconciliation to avoid denials and claim resubmissions
  • Develops process improvement initiatives to reduce billing inefficiencies or inaccuracies

Pharmacy Reimbursement Division Leadership

  • Ellen Secaras

    Ellen Secaras, RPh

    Pharmacy Clinical Systems Integration Manager
  • Camille Dieudonne

    Camille Dieudonne, PharmD

    Pharmacy Clinical Financial Analyst, Corporate Pharmacy at RWJBarnabas Health
  • Berna Sweeney

    Berna Sweeney, BS, CPhT

    Pharmacy Reimbursement Specialist, Corporate Pharmacy at RWJBarnabas Health

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