Pharmacy Revenue & Reimbursement Analyst

Texas Health Resources•Arlington, TX

1d•Remote

About The Position

Bring your passion to Texas Health so we are Better + Together. This is a Remote Position. Gain a sense of accomplishment by contributing to a teamwork environment.

Requirements

Bachelor's Degree Business, Finance, Analytics, Healthcare Administration, Accounting, or related field Req Or H.S. Diploma or Equivalent 10 Years CPhT with 10+ years of experience with pharmacy revenue cycle, retail pharmacy operations and billing, as well as 340B Req
3 Years Experience in healthcare and/or pharmacy reimbursement, revenue cycle, or financial analysis; experience working with PBMs, health plans, or healthcare provider systems. Req or 5 Years Pharmacy reimbursement analysis, collections, or revenue integrity experience; 340B program experience (e.g., split billing/accumulation oversight, claim qualification troubleshooting, audit support, or contract pharmacy operations) preferred. Pref
CPhT - Certified Pharmacy Technician Upon Hire Req
ASHP Pharmacy Revenue Cycle Certificate 12 Months Req
Extensive knowledge of pharmacy revenue cycle processes, to include PBM contracting, and 340B program concepts such as eligibility/qualifications, split billing, accumulation, replenishment, etc....
Understanding of laws and regulations impacting pharmacy billing and 340B.
Demonstrate intrapersonal skills, a positive demeanor, professional skills/approach, good verbal and written communication skills, as well as initiative and self-motivation.
Must be detail oriented and have strong analytical, critical, and problem-solving skills to support leadership decision making.
Possess ability to work independently, proactively with limited supervision and as a team player when called upon.

Nice To Haves

Epic experience Preferred

Responsibilities

Facilitate and support claims processing, rebills, appeals, and follow-up with PBMs and health plans; identify appeal opportunities and manage payor communications to recover underpayments or resolve payment variances.
Monitor and report aging accounts receivable and key performance metrics (e.g., DSO, applied cash).
Support 340B revenue optimization activities by monitoring payor and accumulator impacts (where applicable), identifying claim-level variances, and collaborating with pharmacy operations and finance to resolve 340B-related reimbursement issues.
Develop reports, dashboards, and ad-hoc analysis for payment variances, denials, underpayments, and other trends to support decision-making and process improvements.
Identify trends related to denials and underpayments; collaborate with appropriate teams to implement improvement initiatives.
Analyze reimbursement from pharmacy claims to validate payment accuracy, ensure compliance with contracted rates, and reconcile claims activity with remittances to ensure payment efficacy.
Perform 340B payment integrity and audit support activities by analyzing claim-level eligibility/accumulator impacts (as applicable), researching exceptions, and preparing documentation for internal/external reviews.
Support 340B split billing and vendor processes (as applicable), including data validation, claim qualification troubleshooting, and reconciliation of replenishment/accumulation outputs.
Support maintenance of third-party payor pharmacy fee schedules, pharmacy charge masters, and contracted pharmacy payment methodologies; evaluate payor contract performance and reimbursement arrangements and support negotiations with data-driven insights.
Provide education stakeholders to drive optimal revenue capture.
Serve as the system expert on medication-related compliance billing and charging topics.
Develop policies and/or guidelines to improve revenue integrity, charge capture, and billing compliance.
Actively research and stay current with important pharmacy billing and revenue related compliance and optimization topics to guide appropriate organizational decisions.