Coral Connect

Operations

• Design, implement, and maintain Coral’s internal 340B quality assurance and compliance framework
• Oversee 340B eligibility validation, accumulator alignment, and financial integrity
• Lead pre- and post-bill reviews to identify and resolve discrepancies
• Conduct monthly and quarterly compliance audits and drive corrective action plans
• Perform cross-entity workflow validation across partner sites
• Develop and maintain KPI and quality reporting dashboards
• Provide HRSA registration and regulatory oversight, including OPAIS validation and registration coordination
• Advise hospital partners on Medicaid carve-in versus carve-out strategy
• Confirm AIC sites are active in OPAIS before 340B dispensing and track approvals
• Ensure compliance with HRSA patient eligibility requirements and infusion documentation standards
• Lead end-to-end program onboarding and implementation across stakeholders and workstreams
• Facilitate kickoff sessions with health system and infusion provider stakeholders, onsite and virtually
• Develop and maintain SOPs for referral, eligibility, order processing, inventory, billing, and audit response
• Direct training for clinical, pharmacy, billing, inventory, and 340B program staff
• Manage pre-go-live testing, timelines, risks, and program launch
• Oversee ongoing eligibility monitoring and TPA data reconciliation
• Maintain records and coordinate audit cooperation
• Lead issue resolution and corrective action processes
• Produce operational reporting for health system and infusion provider leadership
• Lead governance forums, performance reviews, medication review boards, compliance audit reviews, steering committees, and annual program reviews
• Identify optimization opportunities, support leakage reanalysis and network expansion, and drive continuous improvement and scalability

Director, 340B Pharmacy Operations

Compliance

• Lead and assist cross-functional and multidisciplinary projects and collaborate with stakeholders
• Review, interpret, and apply relevant laws, regulations, accreditation standards, and best-practice guidelines
• Develop, review, implement, and maintain policies and procedures
• Advise on compliance, accreditation, quality improvement, and clinical and operational excellence strategies
• Analyze, identify, and evaluate risks using risk-management tools and techniques
• Define quality metrics, coordinate data collection, analyze outcomes, and prepare documentation and reports
• Manage costs within established budget parameters
• Create, plan, implement, and oversee clinical audits supporting accreditation readiness and quality compliance
• Provide technical expertise and ongoing oversight of projects and deliverables
• Consult and advise clients on accreditation, compliance, and quality initiatives
• Plan and implement training and education for stakeholders
• Participate on accreditation assessment teams and review outputs for accuracy and compliance
• Serve as a subject-matter expert in reviewing systems and products and providing supporting documentation
• Support product development through education, quality-process validation, quality-control audits, performance monitoring, and improvement recommendations
• Maintain knowledge of quality standards, laws, regulations, and accreditation requirements
• Update job knowledge through study, education, publications, professional networks, and organizations
• Adhere to company time-tracking standards and policies
• Perform other duties as assigned

Senior Clinical Compliance Manager, Nursing

General Counsel

• Draft, review, and negotiate commercial agreements, including master services agreements, SaaS and data agreements, vendor and sourcing contracts, NDAs, business associate agreements, and statements of work
• Support corporate and transactional work, including governance, entity matters, board and member resolutions, corporate records, financings, diligence, execution, and integration
• Help the business address healthcare and regulatory questions involving 340B, the Anti-Kickback Statute, and HIPAA
• Partner with business, operations, and people teams on day-to-day legal questions
• Support employment questions across the remote, multi-state workforce
• Manage legal risk, disputes, and demands, coordinating with outside counsel as appropriate
• Improve legal templates, playbooks, and tools
• Monitor relevant legal and regulatory changes and provide practical guidance
• Perform other duties as assigned

Senior Corporate Counsel

Billing Specialist

• Review patient accounts for billing readiness and verify required documentation, authorizations, and charges
• Prepare and submit professional, facility, infusion, and pharmacy claims to payers within filing deadlines
• Validate HCPCS, J-Codes, CPT, ICD-10, modifiers, units, and place of service codes
• Bill infusion therapies, specialty pharmacy claims, and home infusion services according to payer and regulatory requirements
• Monitor claim transmission reports, clearinghouse edits, payer edits, adjudication responses, and rejections
• Research, correct, and resubmit rejected claims within established turnaround times
• Coordinate with pharmacy teams regarding prescription, dispensing, reimbursement, and coordination of benefits
• Verify prior authorizations and clinical documentation support billed services
• Review charges for accuracy and completeness, identify missing charges, and support revenue integrity
• Collaborate with intake, prior authorization, cash posting, accounts receivable, clinical, pharmacy, RCM, and client teams
• Participate in client meetings, quality assurance audits, training, special projects, and process improvement initiatives
• Maintain HIPAA and billing-regulation compliance, detailed billing documentation, and adherence to company procedures

Collections

• Manage and follow up on assigned accounts receivable for pharmacy and AIC infusion services
• Work denied, rejected, and underpaid claims to ensure maximum reimbursement
• Contact insurance payers to resolve claim issues, verify claim status, and secure payment
• Review Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERAs) to identify discrepancies
• Investigate and resolve billing errors, coding issues, and authorization-related denials
• Submit appeals and supporting documentation as needed
• Monitor aging reports and prioritize accounts based on timely filing limits and reimbursement impact
• Collaborate with billing, coding, intake, and clinical teams to resolve claim issues
• Identify trends in denials or payer behavior and escalate systemic issues
• Maintain accurate documentation of all collection activities in the system
• Ensure compliance with payer requirements, HIPAA regulations, and company policies
• Assist with patient account inquiries, including balance questions and payment arrangements as applicable
• Support month-end reporting and AR reconciliation activities

Collections Specialist

Procurement

• Own and grow Coral's upstream GPO contracts, manufacturer agreements, and wholesale/distributor partnerships.
• Lead negotiation and ongoing management of member-distributor agreements and member-manufacturer agreements.
• Develop and manage downstream channel relationships with member facilities, specialty networks, and purchasing cooperatives.
• Monitor market dynamics and proactively adjust strategy to protect and grow client savings.
• Build the operational infrastructure and data standards for contract ingestion and management.
• Manage and grow Coral's portfolio of GPO contracts with pharmaceutical manufacturers and medical supply vendors.
• Negotiate and administer Enhanced Data Service Agreements with manufacturers.
• Own post-admin discount program administration.
• Own and develop the new GPO member acquisition pipeline.
• Develop and maintain customer-specific savings roadmaps and execution plans for every active GPO member.

Director, 340B Pharmacy Operations

Senior Clinical Compliance Manager, Nursing

Senior Corporate Counsel

Billing Specialist

Collections Specialist

EVP, Market Access and Strategic Sourcing