Pharmacy Revenue Cycle Specialist
About The Position
This position is responsible for ensuring optimal revenue capture for pharmaceuticals across the entirety of the revenue cycle. The Pharmacy Revenue Integrity Specialist will: - Serve as a liaison between Finance, Revenue Integrity, Payer Relations & Decision Support, Compliance & Auditing, Pharmacy, Supply Chain, the 340B team and other departments to optimize pharmacy charging workflows, pharmacy revenue, business processes, billing, denial management, and collections. - Work with sites, managed care, and the business office to decrease medication-related claim denials and outstanding claims - Collaborate with pharmacy clinical, 340B team and Payer Relations for financial analysis of formulary additions and changes proposed to P&T - Provide education to site and system stakeholders to drive optimal revenue capture - Act as the system expert on medication-related compliance billing and charging topics - Develop policies and/or guidelines to improve pharmacy revenue integrity, capture, and billing compliance - Work with 340B pharmacy analysts for system price updates and auditing of changes - Assess charge issues and audits from 340B pharmacy analysts for solutions - Participate in the financial analyses of any proposed changes to determine charge and revenue implications related to the pharmacy charge description master (PCDM) maintenance. - Communicate findings to management and overseeing the implementation of approved recommendations to ensure appropriate revenue capture. This individual will collaborate with the Pharmacy leadership team to achieve departmental and organizational goals, meet customer needs and assure high quality services and products. Strong interpersonal communication skills and organizational skills. Consistently demonstrates ability to respond to changing priorities and situations in a flexible manner in order to meet current needs. Demonstrated ability to manage and prioritize tasks with attention to detail. Ability to work in a team environment, use a computer for communication, writing and research. Expertise with Microsoft Office including Word, Excel, PowerPoint, and Outlook.
Requirements
- Minimum of a PharmD from an accredited program
- A Current and Valid license to practice pharmacy in the State of Tennessee
- One year hospital pharmacy experience
- Strong interpersonal communication skills and organizational skills
- Consistently demonstrates ability to respond to changing priorities and situations in a flexible manner in order to meet current needs
- Demonstrated ability to manage and prioritize tasks with attention to detail
- Ability to work in a team environment, use a computer for communication, writing and research
- Expertise with Microsoft Office including Word, Excel, PowerPoint, and Outlook
Nice To Haves
- MBA or MHA
- Hospital EHR experience
- Revenue Cycle or Financial analysis experience
- ASHP Revenue Cycle Certificate
Responsibilities
- Develop policies, guidelines, and procedures for pharmaceutical coding, billing, pricing, charging, and denial management to maximize reimbursement and compliant charging
- Develop quality metrics and audit methodologies to drive accuracy and first-time quality for all HCPCS/CPT codes, revenue codes, billable units, multipliers, modifiers, indications, etc.
- Optimize analytical tools to audit and analyze hospital pharmacy data elements to ensure accurate billing and maximal revenue capture
- Perform quality reviews in order to ensure that PCDM additions, inactivation's, changes and/or revisions were accurately completed in the hospitals clinical and financial systems
- Work with Pharmacy & Therapeutics Committees, Oncology Service Lines, and Managed Care to align formularies
- Actively research and stay current with important billing and revenue related compliance and optimization topics to guide appropriate organizational decisions
- Participate and lead committees, work groups, process improvement efforts, and educational initiatives to improve pharmacy revenue integrity and the pharmacy billing cycle.
- Develop process flows, education, and communications to improve revenue integrity and compliance
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Ph.D. or professional degree
Number of Employees
1,001-5,000 employees
