Pharmacy Revenue Cycle Analyst

Job not on LinkedIn

🕒 August 6

🐎 Kentucky – Remote

🐎 Kentucky – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

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Baptist Health System KY & IN

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1924

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

Baptist Health System KY & IN is a comprehensive healthcare provider operating in Kentucky and Southern Indiana. It offers a wide range of services such as behavioral health, cancer care, gastroenterology, heart care, imaging and diagnostics, and specialized care for mother and baby, neurology, stroke, orthopedics, and sports medicine. The system provides various types of care including emergency, urgent, and virtual care, and supports digital health through their MyChart app. Baptist Health is committed to community health through outreach programs, education, and research, and emphasizes patient safety and quality care across its numerous locations. It offers extensive career opportunities in healthcare and strives for transparency and patient-centered care.

📋 Description

• Ensure optimal revenue capture for pharmacy services and maximize financial performance • Monitor pharmacy revenue cycle performance, charge capture, coding, claims processing, denials, and write-off assessments • Analyze, update, and correct inpatient, outpatient, commercial, Medicare, Medicaid, MCO, and community pharmacy PBM claims data • Collaborate with accounts receivable on billing, payment auditing, credits, and patient-account follow-up • Coordinate with sites, managed care, and business offices to reduce medication-related denials, underpayments, and outstanding claims • Review, investigate, and process high-dollar and high-dispense-quantity work queue items • Serve as system expert on medication-related compliance billing and charging • Perform quality reviews of pharmacy charge description master changes in clinical and financial systems • Support pharmacy contract negotiations through payment models, payment auditing, denial management, profitability reporting, and payer analysis • Collaborate with clinical staff, departments, and physician offices to obtain documentation and coding reviews for appeals • Follow up on accounts through resolution or exhaustion of reasonable appeal options • Assist with contract compliance and identify savings opportunities • Work with IT and software vendors to test and implement payment-modeling software upgrades • Develop quality metrics and audit methodologies for HCPCS/CPT codes, revenue codes, billable units, multipliers, modifiers, and indications • Assist with analytical tools for prospective and retrospective audits and data analysis • Maintain pharmacy revenue cycle scorecards, dashboards, and key performance indicators • Audit price-file updates from wholesalers, Epic, charges, and patient information • Develop reports comparing proposed and actual financial impact by contract term • Educate site and system stakeholders on revenue capture and compliance • Assist with policies, guidelines, and procedures for pharmaceutical coding, billing, pricing, charging, and denial management • Participate in committees, work groups, process-improvement efforts, and educational initiatives

🎯 Requirements

• Bachelor's degree and 3 years minimum job-related experience • Four additional years of experience may be substituted for a degree • Strong knowledge of general ledger accounts and coding • Preferred accounting, finance, or equivalent college-level accounting courses • Preferred HCS-D, HCS-O, or COS-C certification • Preferred hospital and community-based billing and compliance experience • Preferred experience in CDM maintenance • Preferred direct healthcare experience

🏖️ Benefits

• Remote work arrangement • Equal Employment Opportunity employer • Drug-free workplace • Pre-employment drug testing