Pharmacy Revenue Cycle Analyst

The Pharmacy Revenue Cycle Analyst is responsible for helping ensure optimal revenue capture for pharmacy services and supporting financial performance.

This role monitors revenue cycle performance by reviewing pharmacy charge capture, coding pharmacy charges accurately, ensuring inpatient and outpatient claims are processed correctly, and reviewing denials and write-off assessments. It also supports pharmacy leadership with managed care payment models, payment auditing, and denial management.

Additional responsibilities include:

• Ensuring billing for inpatient, outpatient, commercial, Medicare, Medicaid, MCO, and community pharmacy PBM accounts by analyzing and correcting claims data
• Working with accounts receivable to support accurate billing, payment auditing, credits, and follow-up on patient accounts
• Coordinating with sites, managed care, and the business office to reduce denials, underpayments, and outstanding claims
• Reviewing and processing high-dollar and high-dispense quantity work queue items
• Serving as the system expert for medication-related compliance billing and charging
• Performing quality reviews for pharmacy charge description master updates and revisions
• Supporting contract negotiations through payment models, reporting, and profitability analysis
• Assisting with appeals and follow-up until resolution or exhaustion of appeal options
• Supporting contract compliance and identifying savings opportunities
• Working with IT and software vendors to test and implement payment modeling software upgrades
• Developing quality metrics and audit methodologies for HCPCS/CPT codes, revenue codes, billable units, multipliers, modifiers, and indications
• Assisting with analytical tools for audits and data analysis
• Maintaining pharmacy revenue cycle scorecards, dashboards, and key performance indicators
• Auditing price file updates from wholesalers, Epic, charges, and patient information
• Preparing reports showing proposed versus actual financial impact by contract term
• Educating site and system stakeholders on revenue capture and compliance
• Helping develop policies, guidelines, and procedures related to pharmaceutical coding, billing, pricing, charging, and denial management
• Participating in committees, work groups, process improvement efforts, and educational initiatives