Pharmacy Revenue Cycle Lead

Methodist Le Bonheur Healthcare; United States; On-site; USD 60,000 - 80,000; Full time

Job summary

Methodist Le Bonheur Healthcare in Memphis seeks a Pharmacy Revenue Cycle Specialist to support charge capture, claims submission, denial management, and reconciliation. You may lead Prior Authorization Specialists, ensuring team performance and billing compliance in a dynamic, patient-centered environment.

You will collaborate with the Revenue Cycle Analyst to identify reimbursement barriers, streamline workflows, and maximize revenue integrity, upholding MLH Mission, Vision, and Values in

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.
• 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 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

Pharmacy billing

Revenue cycle management

Leadership

Communication

Excel

EHR/billing systems

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

Tools

Pharmacy billing software

Microsoft Excel

EHR systems

Billing platforms

Job description

Methodist Le Bonheur Healthcare in Memphis seeks a Pharmacy Revenue Cycle Specialist to support charge capture, claims submission, denial management, and reconciliation. You may lead Prior Authorization Specialists, ensuring team performance and billing compliance in a dynamic, patient-centered environment.

You will collaborate with the Revenue Cycle Analyst to identify reimbursement barriers, streamline workflows, and maximize revenue integrity, upholding MLH Mission, Vision, and Values in