Pharmacy Revenue Cycle Analyst - Remote

Job Description:

Baptist Health is looking for a Remote Revenue Cycle Analyst I to join our Pharmacy team!

• Ensures billing for all inpatient, outpatient commercial, Medicare, Medicaid, MCOs, and community pharmacy PBM accounts by analyzing, updating, and correcting claims data.
• Assures that billing procedures performed by the department are accurate and timely.
• Works collaboratively with accounts receivable.
• Coordinates with sites, managed care, and the business office to decrease medication-related claim denials, underpayments, and outstanding claims.
• Reviews, investigates, and processes high dollar and high dispense quantity work queue items.
• Serves as the system expert on medication-related compliance billing and charging.
• Performs 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.
• Assists Baptist Health’s pharmacy contract negotiating team in developing and maintaining up to date, accurate payment models to assist with the contract management processes (payment auditing and denial management) as well as reporting on current profitability, payor analysis and other key areas of analysis.
• Collaborates with clinical staff, other departments, and physician offices to request assistance (additional documentation, coding review, etc.) when necessary to successfully appeal an account.
• Assists with contract compliance and identify savings opportunities.
• Responsible for working with IT and software vendor to test and implement software upgrades related to payment modeling software.
• Possesses strong analytical skills to identify financial and revenue discrepancies.
• Works with the revenue cycle team and pharmacy leadership to develop quality metrics and audit methodologies.
• Assists with the development and enhancement of analytical tools for prospective and retrospective audits and data analysis.
• Audits price file updates from wholesaler, non-wholesaler, Epic, charges, and patient information.
• Assists with development of policies, guidelines, and procedures for pharmaceutical coding, billing, pricing, charging, and denial management.

Minimum Requirements

• High school diploma or equivalent.
• 3+ years of job-related experience.
• Accounting, Finance, or equivalent college level courses in accounting.
• Hospital and Community based experience with expertise in billing and compliance.
• Experience in CDM maintenance.
• Strong knowledge of general ledger accounts and coding required with experience in healthcare preferred.

If you would like to be part of a growing family focused on supporting clinical excellence, teamwork and innovation, we urge you to apply now!

Baptist Health is an Equal Employment Opportunity employer.