Pharmacy Revenue Cycle Analyst

HH MedStar Health Inc.•Elkridge, MD

65d•$28 - $47

About The Position

We are actively recruiting for an experienced Pharmacy Revenue Cycle Analyst to join our system Pharmacy team at MedStar Health. This role is responsible for Hospital Pharmacy billing practices at MedStar and supports ambulatory medication billing practices. Key to this role is investigation and resolution of billing issues and coordination with the Department of Pharmacy, Information Services, Rates and Reimbursement and Patient Financial Services at MedStar. Serves as a resource for pharmacy and ambulatory areas to optimize reimbursement for medications used in these areas and ensure that decisions and systems comply with regulatory requirements. MedStar Health is a great place to work and grow your career. We provide a supportive and inclusive work environment, comprehensive health and wellness benefits, generous PTO, tuition assistance, retirement plans, and many other benefits focused on your wellbeing. Apply today and learn how MedStar Health can be your next great career move! At this time, we are unable to offer visa sponsorship for this position. Applicants must be authorized to work in the United States on a full-time, permanent basis without the need for current or future sponsorship.

Requirements

Bachelor's degree Business or Computer Science required
Minimum of 5 years of related pharmacy hospital billing practices and charge master experience preferred
ASHP Pharmacy Revenue Cycle Management Certificate within 180 Days required
Knowledge Microsoft Office suite Advanced Excel and spreadsheet skills
Proficiency in chargemaster systems and data analysis tools
Ability to meticulously review and verify complex data to ensure accuracy.
Knowledge of healthcare billing regulations and compliance standards for hospitals and ambulatory clinics.
Strong problem-solving skills to identify issues develop solutions and implement corrective actions
Deep understanding of pharmaceutical terminology drug classifications and medication administration practices
HIPAA policies on Confidentiality

Responsibilities

Conducts quality reviews to ensure that pharmacy charge description master (CDM) additions inactivations changes and revisions are accurately completed in the clinical systems and coordinated with the financial systems.
Monitors and analyzes billing issues collaborating with others to identify and rectify the root causes of errors.
Works closely with Revenue Cycle teams Clinic Practice Managers Pharmacy Directors hospital informatics and IS teams to resolve medication billing concerns.
Collaborates with pharmacy staff IT and finance to develop processes and systems that ensure accurate and compliant charges.
Coordinates with the hospital procurement team and ambulatory practice managers to ensure precise assignment of drug codes (NDC codes) to each medication in the chargemaster in accordance with industry standards.
Verifies and adjusts medication pricing based on drug acquisition costs insurance contracts and hospital and ambulatory policies.
Partners with the Rates and Reimbursement team to conduct annual hospital pharmacy cost reviews.
Engages in educating other healthcare professionals regarding the appropriate use and billing of medications
Remains informed about national standards regulations and trends for medication revenue cycle. Ensures chargemaster data complies with federal and state guidelines for medication charging across MedStar including hospitals and ambulatory clinics.
Collaborates with pharmacists and 340b managers at each hospital to promptly address any discrepancies in medication charges.
Generates reports on pharmacy charge trends and conducts regular audits. Analyzes data to identify potential areas for cost optimization and revenue improvement
Utilizes all organizational resources effectively and efficiently.