Pharmacy Revenue Cycle Analyst - Remote

About this role

Summary The Pharmacy Revenue Cycle Analyst is responsible for ensuring optimal revenue capture for pharmacy services provided at Baptist Health to help maximize financial performance. The Pharmacy Revenue Cycle Analyst will monitor revenue cycle performance by reviewing pharmacy charge capture, correctly capturing and coding pharmacy charges, ensuring accuracy of inpatient and outpatient claims processing and reviewing denials and write-off assessments.

The Pharmacy Revenue Cycle Analyst must be knowledgeable of pertinent pharmacy revenue cycle rules and regulations. This role will assist pharmacy leadership in developing and maintaining the payment models for managed care negotiations, payment auditing, and denial management. Job Description: Baptist Health is looking for a Remote Pharmacy Revenue Cycle Analyst to join our Pharmacy team! Ensures billing for all inpatient, outpatient commercial, Medicare, Medicaid, MCOs, and community pharmacy PBM accounts by analyzing, updating, and correcting claims data.

Assures that billing procedures performed by the department are accurate and timely. Works collaboratively with accounts receivable through prompt and accurate billing, payment auditing, credits, and follow up of all patient accounts with Medicare, Medicare Advantage, Medicaid, PBMs, and MCOs. Coordinates with sites, managed care, and the business office to decrease medication-related claim denials, underpayments, and outstanding claims.

Reviews, investigates, and processes high dollar and high dispense quantity work queue items. Serves as the system expert on medication-related compliance billing and charging. Performs quality reviews to ensure that pharmacy charge description master (PCDM) additions, inactivations, changes and/or revisions were accurately completed in the clinical and financial systems. Assists Baptist Health’s pharmacy contract negotiating team in developing and maintaining up to date, accurate payment models to assist with the contract management processes (payment auditing and denial management) as well as reporting on current profitability, payor analysis and other key areas of analysis.