Pharmacy Revenue Cycle Lead

Methodist Le Bonheur Healthcare; Memphis (TN); On-site; USD 65,000 - 85,000; Full time

Job summary

Methodist Le Bonheur Healthcare seeks a Pharmacy Revenue Cycle Specialist to support all phases of the pharmacy revenue cycle, including charge capture, claims submission, denial management, and financial reconciliation. The role may lead Prior Authorization Specialists to ensure compliant and efficient billing.

You will collaborate with the Pharmacy Revenue Cycle Analyst to identify barriers to reimbursement, streamline workflows, and maximize revenue integrity while upholding MLH values and

Qualifications

• Required - Bachelor's Degree Health Science
• Preferred - Bachelor's Degree Allied Health
• Preferred - Bachelor's Degree Computer Sciences
• Preferred - Bachelor's Degree Healthcare Administration
• Preferred - Bachelor's Degree Information Systems
• Preferred - High School Diploma or Equivalent

Responsibilities

• Revenue Cycle Operations: review, validate, and reconcile pharmacy charges to submit or resubmit claims to insurance and/or third-party payors.
• Communicate with the pharmacy team and insurance companies for payment acquisition, pre-authorization, and to resolve patient account inquiries.
• Monitor patient Accounts Receivable and Guarantor accounts.
• Appeal and troubleshoot denials within scope; escalate complex cases to the Analyst.
• Support pre-authorization, billing, and payment reconciliation processes.
• Aid in the resolution and preparation of audit requests with a focus on system improvement and education for pharmacy operations.
• Provide the highest customer service experience for patients and providers.
• Maintain compliance with institutional policies, payor rules, and regulatory standards.

Skills

Leadership

Communication

Coaching

Attention to detail

Education

Bachelor's Degree Health Science

Bachelor's Degree Allied Health

Bachelor's Degree Computer Sciences

Bachelor's Degree Healthcare Administration

Bachelor's Degree Information Systems

High School Diploma or Equivalent

Job description

Methodist Le Bonheur Healthcare seeks a Pharmacy Revenue Cycle Specialist to support all phases of the pharmacy revenue cycle, including charge capture, claims submission, denial management, and financial reconciliation. The role may lead Prior Authorization Specialists to ensure compliant and efficient billing.

You will collaborate with the Pharmacy Revenue Cycle Analyst to identify barriers to reimbursement, streamline workflows, and maximize revenue integrity while upholding MLH values and