Pharmacy Revenue Cycle Analyst

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🕒 May 15

🐎 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 Insurance

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

• The Pharmacy Revenue Cycle Analyst is responsible for ensuring optimal revenue capture for pharmacy services provided at Baptist Health to help maximize financial performance. • Monitor revenue cycle performance by reviewing pharmacy charge capture, correctly capturing and coding pharmacy charges, ensuring accuracy of inpatient and outpatient claims processing and reviewing denials and write-off assessments. • Utilize expertise in coding to ensure efficiency and excellence for patients and providers. • Assist pharmacy leadership in developing and maintaining the payment models for managed care negotiations, payment auditing, and denial management. • Analyze, update, and correct claims data to ensure billing for all inpatient, outpatient commercial, Medicare, Medicaid, MCOs, and community pharmacy PBM accounts is accurate and timely. • Collaborate with accounts receivable through prompt and accurate billing, payment auditing, credits, and follow up of all patient accounts with Medicare, Medicare Advantage, Medicaid, PBMs, and MCOs. • Coordinate with sites, managed care, and the business office to decrease medication-related claim denials, underpayments, and outstanding claims. • Review, investigate, and process high dollar and high dispense quantity work queue items. • Perform quality reviews to ensure that pharmacy charge description master (PCDM) additions, inactivations, changes and/or revisions were accurately completed in the clinical and financial systems. • Assist Baptist Health’s pharmacy contract negotiating team in developing and maintaining up to date, accurate payment models for contract management processes and reporting on current profitability, payor analysis and other key areas of analysis. • Collaborate with clinical staff, other departments, and physician offices to request assistance when necessary to successfully appeal an account. • Ensure appropriate follow ups on accounts until a resolution is reached or all reasonable appeal options are exhausted. • Assist with contract compliance and identify savings opportunities. • Test and implement software upgrades related to payment modeling software with IT and software vendor. • Develop quality metrics and audit methodologies to drive accuracy and first-time quality for all HCPCS/CPT codes, revenue codes, billable units, multipliers, modifiers, and indications. • Assist with the development and enhancement of analytical tools for prospective and retrospective audits and data analysis. • Coordinate the overall maintenance of all pharmacy revenue cycle scorecards, dashboards and key performance indicators. • Audit price file updates from wholesaler, non-wholesaler, Epic, charges, and patient information. • Develop reports to highlight the proposed vs. actual financial impact by contract term. • Provide education to site and system stakeholders to drive optimal revenue capture and compliance. • Assist with development of 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. • 4 years additional experience may be substituted for a degree. • Strong knowledge of general ledger accounts and coding. • Accounting, Finance, or equivalent college level courses in accounting (preferred). • Home Care Specialist-Diagnosis (HCS-D) (preferred). • Home Care Specialist – Oasis (HCS-O) or Certificate for OASIS Specialist – Clinical (COS-C) (preferred). • Hospital and Community based experience with expertise in billing and compliance (preferred). • Experience in CDM maintenance (preferred). • Direct experience in healthcare (preferred).

🏖️ Benefits

• Baptist Health is an Equal Employment Opportunity employer • Drug-free workplace