Pharmacy Revenue Cycle Analyst - Remote

Baptist Health - Hazard, KY

Full-time - Entry Level

Remote - Hazard, KY

1,001-5,000 employees

Hospitals

About the position

Baptist Health is seeking a Remote Revenue Cycle Analyst I to join our Pharmacy team. This role is crucial in ensuring accurate billing for all inpatient, outpatient commercial, Medicare, Medicaid, MCOs, and community pharmacy PBM accounts. The analyst will be responsible for analyzing, updating, and correcting claims data to ensure that billing procedures performed by the department are both accurate and timely. Collaboration with accounts receivable is essential, as well as coordination with various sites, managed care, and the business office to minimize medication-related claim denials, underpayments, and outstanding claims. The Revenue Cycle Analyst I will review, investigate, and process high dollar and high dispense quantity work queue items, serving as the system expert on medication-related compliance billing and charging. Quality reviews will be performed to ensure that pharmacy charge description master (PCDM) additions, inactivations, changes, and/or revisions are accurately completed in both clinical and financial systems. The analyst will assist Baptist Health's pharmacy contract negotiating team in developing and maintaining up-to-date, accurate payment models to support contract management processes, including payment auditing and denial management, as well as reporting on current profitability and payor analysis. Collaboration with clinical staff, other departments, and physician offices will be necessary to request assistance when needed to successfully appeal an account. The analyst will also assist with contract compliance and identify savings opportunities. This position requires working with IT and software vendors to test and implement software upgrades related to payment modeling software. Strong analytical skills are essential to identify financial and revenue discrepancies, and the analyst will work with the revenue cycle team and pharmacy leadership to develop quality metrics and audit methodologies. Additionally, the analyst will assist in the development and enhancement of analytical tools for both prospective and retrospective audits and data analysis, audit price file updates from wholesalers, non-wholesalers, Epic, charges, and patient information, and help develop policies, guidelines, and procedures for pharmaceutical coding, billing, pricing, charging, and denial management.

Responsibilities

• Ensure accurate billing for inpatient, outpatient commercial, Medicare, Medicaid, MCOs, and community pharmacy PBM accounts.
• Analyze, update, and correct claims data to ensure timely billing procedures.
• Collaborate with accounts receivable and coordinate with sites, managed care, and the business office to reduce claim denials and underpayments.
• 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 of pharmacy charge description master (PCDM) changes in clinical and financial systems.
• Assist in developing and maintaining accurate payment models for pharmacy contract negotiations.
• Collaborate with clinical staff and other departments to request additional documentation or coding reviews for successful 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 through strong analytical skills.
• Develop quality metrics and audit methodologies with the revenue cycle team and pharmacy leadership.
• Assist in the development of analytical tools for audits and data analysis.
• Audit price file updates from various sources and assist in developing coding and billing policies.

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 healthcare experience preferred.