Pharmacy Revenue Cycle Analyst - Remote

Baptist Health

Full-time - Mid Level

Remote

1,001-5,000 employees

Hospitals

About the position

The Pharmacy Revenue Cycle Analyst I at Baptist Health is responsible for ensuring accurate billing for various pharmacy accounts, including inpatient, outpatient, Medicare, Medicaid, and commercial accounts. This role involves analyzing and correcting claims data, collaborating with accounts receivable, and coordinating with various departments to minimize claim denials and underpayments. The analyst will also serve as a system expert on medication-related compliance billing, perform quality reviews, assist in contract negotiations, and develop analytical tools for audits and data analysis.

Responsibilities

• Ensure billing for all inpatient, outpatient, commercial, Medicare, Medicaid, MCOs, and community pharmacy PBM accounts by analyzing, updating, and correcting claims data.
• Assure that billing procedures performed by the department are accurate and timely.
• Work collaboratively with accounts receivable.
• 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.
• Serve as the system expert on medication-related compliance billing and charging.
• Perform quality reviews to ensure accurate completion of pharmacy charge description master (PCDM) additions, inactivations, changes, and revisions in clinical and financial systems.
• Assist in developing and maintaining accurate payment models for contract management processes.
• Collaborate with clinical staff and other departments to request assistance for successful account appeals.
• Assist with contract compliance and identify savings opportunities.
• Work with IT and software vendors to test and implement software upgrades related to payment modeling software.
• Identify financial and revenue discrepancies using strong analytical skills.
• Develop quality metrics and audit methodologies with the revenue cycle team and pharmacy leadership.
• Assist in the development and enhancement of analytical tools for audits and data analysis.
• Audit price file updates from wholesalers, non-wholesalers, Epic, charges, and patient information.
• Develop policies, guidelines, and procedures for pharmaceutical coding, billing, pricing, charging, and denial management.

Requirements

• High school diploma or equivalent.
• 3+ years of job-related experience.
• Accounting, Finance, or equivalent college-level courses in accounting.
• Hospital and community-based experience with expertise in billing and compliance.
• Experience in CDM maintenance.
• Strong knowledge of general ledger accounts and coding, with experience in healthcare preferred.