Pharmacy Revenue Integrity & Compliance Analyst

3B Healthcare, Inc.; Roseville (CA); On-site; USD 85,000 - 110,000; Full time

Job summary

Adventist Health Roseville and associated service teams seek a Pharmacy Revenue Integrity Specialist to ensure accurate billing and compliant charge capture across outpatient departments. You will serve as a bridge between pharmacy operations, revenue cycle, compliance, and finance, leveraging knowledge of pharmacy workflows and payer requirements.

The role requires at least three years in hospital pharmacy revenue, a CA/OR/HI license, and familiarity with EMR billing systems.

Qualifications

• Three years of hospital pharmacy/revenue integrity experience required.
• State Pharmacy Technician license required (CA, OR, or HI).
• Experience with EMR/billing systems preferred (Epic/Cerner).

Responsibilities

• Reviews and reconciles medication charges in outpatient encounters.
• Ensures alignment with CMS, HRSA, and payer guidelines.
• Identifies and corrects charge capture errors prior to billing.
• Monitors UB-04 claim accuracy and proper coding.
• Collaborates with revenue integrity, HIM, and pharmacy to maintain CDM entries.
• Stays current on OPPS updates and payer requirements.
• Supports claim denials resolution related to outpatient drug charges.

Skills

Pharmacy billing

Revenue integrity

CMS guidelines

EMR workflows

Education

Associate's/Technical degree (preferred)

Tools

Epic Resolute

Cerner Revenue Cycle

Job description

Adventist Health Roseville and associated service teams seek a Pharmacy Revenue Integrity Specialist to ensure accurate billing and compliant charge capture across outpatient departments. You will serve as a bridge between pharmacy operations, revenue cycle, compliance, and finance, leveraging knowledge of pharmacy workflows and payer requirements.

The role requires at least three years in hospital pharmacy revenue, a CA/OR/HI license, and familiarity with EMR billing systems.