Revenue Integrity Specialist - Specialty Pharmacy

methodisthealth; Indianapolis (IN); On-site; USD 52,000 - 72,000; Full time

Job summary

Methodist Le Bonheur Health is seeking a Pharmacy Revenue Cycle Specialist to support all phases of the pharmacy revenue cycle, including charge capture, claims submission, denial management, and financial reconciliation.

This role may lead Prior Authorization Specialists and work with the Revenue Cycle Analyst to improve workflows and maximize reimbursement while ensuring compliance with billing requirements.

Qualifications

• Experience in pharmacy billing and revenue cycle processes.
• Ability to train others on pharmacy billing practices and procedures.
• Knowledge of payer rules, denials, and pre-authorization workflows.

Responsibilities

• Review, validate, and reconcile pharmacy charges for claims submission.
• Communicate with pharmacy team and payors to secure payment and resolve inquiries.
• Monitor patient Accounts Receivable and Guarantor accounts.
• Resolve denials and escalate complex cases as needed.
• Support pre-authorization, billing, and payment reconciliation processes.
• Assist in audit requests and process improvement initiatives.
• Provide excellent customer service to patients and providers.

Skills

Billing knowledge

Communication

Analytical thinking

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

If you are looking to make an impact on a meaningful scale, come join us as we embrace the Power of One!

We strive to be an employer of choice and establish a reputation for being a talent rich organization where Associates can grow their career caring for others. For over a century, we've served the health care needs of the people of Memphis and the Mid-South.

The Pharmacy Revenue Cycle Specialist position is responsible for supporting all phases of the pharmacy revenue cycle, including charge capture, claims submission, denial management, and financial reconciliation. In addition to performing hands-on revenue cycle duties, this role may act as a lead for the Prior Authorization Specialists, ensuring effective team performance and compliance with billing requirements. The Specialist collaborates with the Pharmacy Revenue Cycle Analyst to identify and address barriers to reimbursement, streamline workflows, and maximize revenue integrity. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

Working at MLH means carrying the mission forward of caring for our community and impacting the lives of patients in every way through compassion, a deliberate focus on service expectations and a consistent thriving for excellence.

A Brief Overview

The Pharmacy Revenue Cycle Specialist position is responsible for supporting all phases of the pharmacy revenue cycle, including charge capture, claims submission, denial management, and financial reconciliation. In addition to performing hands-on revenue cycle duties, this role may act as a lead for the Prior Authorization Specialists, ensuring effective team performance and compliance with billing requirements. The Specialist collaborates with the Pharmacy Revenue Cycle Analyst to identify and address barriers to reimbursement, streamline workflows, and maximize revenue integrity. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

What you will do 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; elevate 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.

Data & Reporting

• Track and log billing denials, claim edits, and resolution outcomes.
• Assist the Pharmacy Revenue Cycle Analyst with generating routine reports on charge trends, denial rates, and PA metrics.
• Report discrepancies or compliance concerns promptly to the Analyst.
• Document revenue cycle activities to meet accrediting agency, payor, and administrative requirements.

Process Improvement & Collaboration

• Identify workflow inefficiencies and recommend improvements to the Analyst.
• Assist in implementing new billing tools, policies, and technologies.
• Serve as a liaison between the PA team, pharmacy operations, and finance.
• Promote a culture of accuracy, accountability, and customer service across the team.

Communication/Training

• Provide training and in-services to others on pharmacy billing procedures and practices.
• Interfaces closely with pharmacists, Social Work, Financial Counseling, Patient Access/Registration, Nurses, and Physicians.
• Understand the importance of effective business communication and maintaining professionalism in difficult situations.
• Participate in the orientation of pharmacy technicians, pharmacists, pharmacy residents, and others within the department on pharmacy billing practices.
• Participate in the training of pharmacy technicians, pharmacists, pharmacy residents, and others within the department on pharmacy billing practices.

Education/Formal Training Requirements

• 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

Work Experience Requirements

• Required - Pharmacy billing 1-3 years
• Required - Revenue cycle 1-3 years

Licenses and Certifications Requirements

• Required - Pharmacy Technician - Tennessee - Tennessee Board of Pharmacy
• Required - Certified Pharmacy Technician - Pharmacy Technician Certification Board
• Preferred - Pharmacy Technician - Mississippi - Mississippi Board of Pharmacy
• Preferred - Certified Pharmacy Technician- ExCPT - National Healthcareer Association

Knowledge, Skills and Abilities

Knowledge of t