Revenue Cycle Management System Specialist

Ardon•Portland, OR

1d•$75,266 - $103,505

About The Position

As we continue to grow, we are seeking a Revenue Cycle Management System Specialist to join our award-winning specialty pharmacy team. About Ardon Health At Ardon, we are passionate about our mission to inspire people and improve lives through the delivery of high-quality, compassionate healthcare services. Our innovative work environment in Portland, Oregon, centers around uplifting collaboration with our employees as we care for patients. Our commitment to cultivating talent and fostering growth within our organization keeps Ardon ranked among the top 100 companies to work for in Oregon. Recognized as a Top Workplace by the Oregonian in 2021, 2022, and 2023 Our specialty pharmacy Our state-of-the-art specialty pharmacy provides medications that are often used to treat complex or rare conditions. We deliver services to enhance the patient experience within the comfort of their home. We remove barriers to care and provide patients with the education, clinical care and supportive services they need on their treatment journey. We work to build trusted relationships and to be a resource where patients can turn for help. What it’s like to work with our team Our progressive work environment embodies the notion that life is meant to be shared and lived well, through hard work, compassion, and camaraderie. Together, we e njoy team meals and celebrate events and company milestones. Employees like to relax in our lounge equipped with amenities that promote wellness and fun. We volunteer to support patient advocacy organizations within our community. Our employee-run DEI Group is dedicated to diversity and inclusion. To learn more about our team and what we do , watch our video at https://vimeo.com/320864889 . Join us! Do you want a dynamic career opportunity where you can make a difference? Explore the potential of your pharmacy experience in an elevated role. The Revenue Cycle Management System Specialist functions as the primary reimbursement authority within the pharmacy department, holding responsibility for comprehensive revenue cycle outcomes related to high-cost specialty medications and infusion services. This position oversees the identification and resolution of billing, coding, and documentation concerns affecting reimbursement processes, specifically for medications covered under both pharmacy and medical benefits. Acting as a subject matter expert and liaison, the Specialist collaborates with internal teams, external partners, payors, suppliers, and vendors to enhance value and ensure optimal program operation and contractual adherence. Additionally, the Specialist is responsible for ensuring accurate charge capture, regulatory-compliant documentation, and prompt reimbursement, all while promoting a seamless experience for patients, prescribers, payers, and internal stakeholders

Requirements

Bachelor’s degree or equivalent in pharmacy, public health, finance, computer science, or a related field.
Minimum of 5 years’ work experience in payer relations, medical and/or pharmacy billing, or an equivalent combination of education and/or relevant work experience; 2+ years in specialty pharmacy and/or infusion pharmacy environment strongly preferred
Strong analytical, problem-solving, and planning skills.
Ability to rapidly develop proficiency and build upon new and existing systems and tools.
Ability to work both independently and collaboratively in a dynamic healthcare environment.
ASHP Pharmacy Revenue Cycle Management Certificate required within 180 Days
A thorough understanding of third-party reimbursement procedures, claims adjudication, and medical terminology is essential for the success of this role.
Must have strong communication, internal and external relationship development skills.
Must be able to demonstrate excellent organizational, project management and time management skills.
Must be able to identify issues, collect data, establish facts and draw valid conclusions.
Must have a proactive approach with the ability to anticipate needs and self-direct to ensure accountabilities are fulfilled.
Must have strong analytical skills with attention to detail.
Must have excellent verbal, written, and interpersonal communication skills.
Must be able to express oneself, detect, perceive, observe, and assess information exchanged in a variety of communication methods.
Must be able to demonstrate proficiency with computer applications.
Must be able to work independently as well as part of a team.
Must be able to multi-task and work in a fast-paced environment.
Work is performed primarily at a desk, with extensive keyboard work in a stationary position.
Business needs may occasionally require work in excess of 40 hours per week, including work outside of the standard workweek.
Internally with Ardon employees across multiple departments.
Externally with providers, payers, vendors, and plans.

Nice To Haves

Experience in the pharmaceutical, PBM, health plan and/or specialty/infusion pharmacy.
Experience with EPIC, Cerner, or other EMR systems and healthcare interoperability platforms.
Working knowledge of HRSA 340B regulations, general program guidelines, and overall CMS compliance frameworks.
Previous experience with 340B Drug Pricing Programs, including knowledge of 340B TPAs (e.g., Macro Helix, Sentry, Verity), wholesaler portals, and pharmacy management systems.
Analytical proficiency with Excel and data visualization/reporting tools.
Familiarity with ScriptMed, Brightree, or other specialty and infusion pharmacy dispensing platforms.
Experience with analyzing and reporting on claims level data to identify potential opportunities for revenue improvements.
Established time management skills prioritizing/organizing and tracking details and timelines of multiple projects with variable completion dates.

Responsibilities

Collaborates cross-functionally with operations, procurement, finance, and purchasing partners to implement systemic improvements that enhance revenue performance.
Assists in the creation of program process flows, training materials, business rule documents, quick reference guides and SOPs.
Evaluates and optimizes billing workflows by establishing reporting tools and dashboards to monitor billing processes, claims correction, and reimbursement trends.
Interprets and applies payer policies, CMS guidance, and billing requirements including CPT/HCPCS codes, NDC crosswalks, and 340B regulations to support compliant billing practices and ensure appropriate reimbursement for dispensed and administered medications.
Establishes and maintains a strong knowledge of payer program requirements to manage payer contracts and ensure proper payment adjudication based on contractual rates.
Collaborates with internal teams, clients, and payers to enhance and optimize reimbursement processes by implementing automated appeals, adjustments, and follow-up procedures.
Validates and coordinates adjustments to medication pricing based on drug acquisition costs, insurance contracts, and internal policies.
Audits and analyzes claims systems to identify and correct coding and charge capture discrepancies impacting reimbursement. Proactively coordinates resolution of pharmacy charge errors and payer reimbursement appeals.
Performs internal quality audits and analyzes information to build recommendations to reduce errors and continuously improve program compliance.
Assists in completing external vendor audits and quality checks.
Assists with payer communication on program activity, escalations, and contract performance status as requested.
Generates reports on pharmacy billing and reimbursement trends and conducts regular audits. Analyzes data to identify potential areas for cost optimization and revenue improvement.
Responds to client inquiries within expected timeframes according to program requirements and leadership direction.
Actively participates and provides support as needed to leadership and operational staff to ensure activities related to the company’s revenue cycle management program maintain priority focus and are effectively executed.
Remains informed about national standards, regulations, and trends in medication revenue cycle.
Complies with the company’s Human Resources policies, Employee Handbook, Code of Conduct, and all department policies and procedures, including protecting confidential company, employee, and customer information; attending work punctually and regularly; and adhering to good safety practices in all activities.
Performs other duties and responsibilities as assigned.