Pharmacy Revenue Cycle Analyst - Remote

BHS Baptist Healthcare System; Kentucky; Hybrid; USD 65,000 - 90,000; Full time

Job summary

Baptist Health in Kentucky seeks a Remote Pharmacy Revenue Cycle Analyst to ensure optimal revenue capture for pharmacy services. You will analyze inpatient/outpatient billing, manage denials, and support contract negotiations and payment modeling with IT and clinical teams.

Responsibilities include reviewing charges, ensuring accurate CPT/HCPCS coding, and driving first-time quality in revenue cycle metrics. Equal opportunity employer.

Qualifications

• Bachelor's degree and 3 years minimum job-related experience.
• Strong knowledge of general ledger accounts and coding.
• Experience in pharmacy billing and compliance.

Responsibilities

• Analyze and correct claims data to ensure accurate billing.
• Collaborate with accounts receivable for timely billing and follow-up with Medicare, Medicaid, PBMs, and MCOs.
• Reduce denials and underpayments; manage write-offs and appeals as needed.
• Develop and maintain payment models for managed care negotiations and denial management.
• Test and implement software upgrades related to payment modeling.

Skills

Revenue cycle knowledge

Denial management

Billing accuracy

Education

Bachelor's degree

Tools

Epic

Job description

Summary

The Pharmacy Revenue Cycle Analyst is responsible for ensuring optimal revenue capture for pharmacy services provided at Baptist Health to help maximize financial performance. The Pharmacy Revenue Cycle Analyst will 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. The Pharmacy Revenue Cycle Analyst must be knowledgeable of pertinent pharmacy revenue cycle rules and regulations. This role will assist pharmacy leadership in developing and maintaining the payment models for managed care negotiations, payment auditing, and denial management.

Job Description

Baptist Health is looking for a Remote Pharmacy Revenue Cycle Analyst 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 through prompt and accurate billing, payment auditing, credits, and follow up of all patient accounts with Medicare, Medicare Advantage, Medicaid, PBMs, and MCOs. 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. Ensures appropriate follow ups on accounts until a resolution is reached or all reasonable appeal options are exhausted. 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. Works with the revenue cycle team and pharmacy leadership to 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. Assists with the development and enhancement of analytical tools for prospective and retrospective audits and data analysis. Coordinates the overall maintenance of all pharmacy revenue cycle scorecards, dashboards and key performance indicators. Audits price file updates from wholesaler, non-wholesaler, Epic, charges, and patient information. Responsible for developing reports to highlight the proposed vs. actual financial impact by contract term. Provides education to site and system stakeholders to drive optimal revenue capture and compliance. Assists with development of policies, guidelines, and procedures for pharmaceutical coding, billing, pricing, charging, and denial management. Participates in committees, work groups, process improvement efforts, and educational initiatives.

QUALIFICATIONS REQUIRED

• 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.

PREFERRED

• Accounting, Finance, or equivalent college level courses in accounting.
• Home Care Specialist-Diagnosis (HCS-D.
• Home Care Specialist – Oasis (HCS-O) or Certificate for OASIS Specialist – Clinical (COS-C).
• Hospital and Community based experience with expertise in billing and compliance.
• Experience in CDM maintenance.
• Direct experience in healthcare.

Baptist Health is an Equal Employment Opportunity employer.

Founded in 1924 in Louisville, Kentucky, Baptist Health is a full-spectrum health system dedicated to improving the health of the communities it serves. The Baptist Health family consists of 10 hospitals, employed and independent physicians, and more than 470 points of care, including outpatient facilities, physician practices and services, urgent care clinics, outpatient diagnostic and surgery centers, home care, fitness centers, and occupational medicine and physical therapy clinics. Baptist Health’s eight owned hospitals include more than 2,300 licensed beds in Corbin, Elizabethtown, La Grange, Lexington, Louisville, Paducah, Richmond and New Albany, Indiana. Baptist Health also operates two joint venture hospitals: the 410-bed Baptist Health Deaconess Madisonville in Madisonville, Kentucky with Deaconess Health System based in Evansville, Indiana, and the Baptist Health Rehabilitation Hospital, a 40-bed inpatient rehabilitation facility with Encompass Health, based in Birmingham, Alabama. Baptist Health employs more than 24,000 people in Kentucky and surrounding states.

EEO Statement

Baptist Health is an Equal Employment Opportunity employer, and seeks to employ individuals without regard to race, color, national origin, gender, sexual orientation, gender identity, age, disability, marital status, citizenship status, military status, religious or political beliefs, protected veteran status, employment status or any other protected class identified in any federal, state, or local law. Baptist Health specifically encourages minority, female, disabled, veteran and other candidates from diverse backgrounds to apply and strengthen our team. Please note that Baptist Health is a drug‑free workplace and employment with Baptist Health is subject to post‑offer, pre‑employment drug testing. NOTICE OF NONDISCRIMATION AND ACCESSIBILITY TO SERVICES Persons with hearing and speech impairments can contact Baptist Health facilities by using the Kentucky Relay Service, a toll‑free telecommunication device for the deaf (TDD). For voice to TDD, call 800.648.6057. For TDD to voice, call 800.648.6056.