Pharmacy Revenue Cycle Analyst - Remote

Baptist Health - Louisville, KY

Full-time

Remote - Louisville, KY

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 and outpatient services. This role involves analyzing and correcting claims data, collaborating with accounts receivable, and coordinating with multiple departments to minimize claim denials and underpayments. The analyst will also perform quality reviews, assist in contract negotiations, and develop analytical tools to enhance revenue cycle processes.

Responsibilities

• Ensure billing accuracy for inpatient, outpatient, and community pharmacy accounts by analyzing and correcting claims data.
• Collaborate with accounts receivable to ensure timely billing procedures.
• Coordinate with sites, managed care, and the business office to reduce medication-related claim denials and underpayments.
• Review 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) updates 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 gather necessary documentation for 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.
• 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 including wholesalers and Epic.
• Develop policies and procedures for pharmaceutical coding, billing, pricing, and denial management.

Requirements

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