System Pharmacy Charge & 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

Description

Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect. Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.

Job Summary

Supports accurate and compliant medication charging, billing, and reimbursement across outpatient hospital departments such as observation units, emergency departments, outpatient surgery centers, and infusion clinics. Ensures medication-related charges are complete, accurate, compliant, and aligned with Centers for Medicare and Medicaid Services (CMS), health resources & services administration (HRSA), and payer regulations. Serves as the bridge between pharmacy operations, revenue cycle, compliance, and finance, using deep understanding of pharmacy workflows, coding, charge capture, and payer requirements to prevent revenue leakage and mitigate compliance risks.

Job Requirements

• High School Education/GED or equivalent: Preferred
• Associate's/Technical Degree or equivalent combination of education/related experience: Preferred
• Three years' of experience in hospital or health system pharmacy, revenue integrity, billing, or compliance: Required
• Experience working in Epic Resolute, Cerner Revenue Cycle, or similar EMR/billing systems: Preferred
• State Pharmacy Technician license: Required (CA, OR, &/or HI)
• Pharmaceutical Technician Board certification: Preferred
• Advanced certification (e.g., CHRI, CRCR, or 340B ACE): Preferred
• State Pharmacy Technician license: Required

Essential Functions

• Reviews and reconciles medication charges in outpatient hospital encounters (e.g., observation, infusion, surgery, emergency department (ED)). Validates NDC-to-HCPCS mapping, billable units, and appropriate modifiers (e.g., JZ/JW) per CMS and payer guidelines.
• Ensures compliance with 340B, GPO, and WAC pricing policies; collaborate with 340B Program Integrity teams to maintain audit readiness.
• Participates in internal and external audits (CMS, HRSA, internal compliance, or payer audits).
• Identifies and corrects charge capture errors prior to billing to ensure clean claims submission.
• Monitors UB-04 claim accuracy for outpatient medication billing and ensure HCPCS and revenue codes align with clinical documentation.
• Collaborates with revenue integrity, HIM, and pharmacy to maintain compliant and optimized CDM (Charge Description Master)/ Medication Record Master File (ERX) entries for medications.
• Stays current on CMS outpatient prospective payment system (OPPS) updates, HRSA guidance, NDC-to-HCPCS quarterly crosswalks, and payer-specific requirements.
• Supports resolution of claim denials related to outpatient drug charges, waste modifiers, medical n...

Requirements

• At least two years recent experience in field, current BLS certification, and a current nursing license per the state of assignment.
• For additional and specialty-specific requirement, please contact us