Pharmacy Revenue Cycle Analyst - Remote

Baptist Health • Hazard, KY

329d • Remote

About The Position

Baptist Health is looking for a Remote Pharmacy Revenue Cycle Analyst to join our Pharmacy team! This position ensures billing for all inpatient, outpatient commercial, Medicare, Medicaid, MCOs, and community pharmacy PBM accounts by analyzing, updating, and correcting claims data. The analyst assures that billing procedures performed by the department are accurate and timely, working 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. The role also coordinates with sites, managed care, and the business office to decrease medication-related claim denials, underpayments, and outstanding claims. The analyst reviews, investigates, and processes high dollar and high dispense quantity work queue items, serving as the system expert on medication-related compliance billing and charging. Additionally, the analyst performs quality reviews to ensure that pharmacy charge description master (PCDM) additions, inactivations, changes and/or revisions are accurately completed in the clinical and financial systems. The role assists Baptist Health's pharmacy contract negotiating team in developing and maintaining up to date, accurate payment models, and helps with pharmacy cost avoidance by maximizing and optimizing existing opportunities, creating new programs and services, and reducing costs. The analyst collaborates with clinical staff, other departments, and physician offices to request assistance when necessary to successfully appeal an account, and assists with contract compliance. Responsibilities also include working with IT and software vendors to test and implement software upgrades related to payment modeling software, developing quality metrics and audit methodologies to drive accuracy and first-time quality, and coordinating the overall maintenance of all pharmacy revenue cycle scorecards, dashboards, and key performance indicators. The analyst audits price file updates from wholesalers, non-wholesalers, Epic, charges, and patient information, and is responsible for developing reports to highlight the proposed vs. actual financial impact by contract term. Education is provided to site and system stakeholders to drive optimal revenue capture and compliance, and the analyst assists with the development of policies, guidelines, and procedures for pharmaceutical coding, billing, pricing, charging, and denial management. Participation in committees, work groups, process improvement efforts, and educational initiatives is also expected.

Requirements

• Bachelor's degree.
• 3 years of work-related experience.
• 4 years of additional experience may be substituted for a degree.
• Strong knowledge of general ledger accounts and coding.

Nice To Haves

• Bachelor's degree in accounting or finance, or equivalent college level courses in accounting.
• Hospital and Community based experience with expertise in billing and compliance.
• Experience in CDM maintenance.
• Direct experience in healthcare.

Responsibilities

• 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.
• 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 are accurately completed.
• Assists pharmacy contract negotiating team in developing and maintaining accurate payment models.
• Assists with pharmacy cost avoidance by maximizing and optimizing existing opportunities.
• Collaborates with clinical staff, other departments, and physician offices to request assistance when necessary.
• Assists with contract compliance.
• Works with IT and software vendor to test and implement software upgrades related to payment modeling software.
• Develops quality metrics and audit methodologies to drive accuracy and first-time quality.
• Coordinates the overall maintenance of all pharmacy revenue cycle scorecards, dashboards, and key performance indicators.
• Audits price file updates from wholesalers, non-wholesalers, Epic, charges, and patient information.
• Develops reports to highlight the proposed vs. actual financial impact by contract term.
• Provides education to site and system stakeholders to drive optimal revenue capture and compliance.
• Assists with development of policies, guidelines, and procedures for pharmaceutical coding, billing, pricing, charging, and denial management.
• Participates in committees, work groups, process improvement efforts, and educational initiatives.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Hospitals
• Education Level: Bachelor's degree