Responsible for execution and performance of retail pharmacy revenue cycle operations within Epic Willow Ambulatory (WAM) and Professional Billing (PB). This role manages accounts receivable follow-up, payment posting, denial resolution, and payment reconciliation to support accurate and timely revenue capture for retail pharmacy services.
The position supports Inspira Health’s transition from third-party A/R management to an internally operated Epic-based revenue cycle model. It serves as an operational liaison between Pharmacy, Revenue Cycle, and Finance to align claim adjudication, remittance processing, and reconciliation workflows.
Key responsibilities include reducing A/R, preventing denials, accelerating cash flow, identifying reimbursement variances, and supporting recovery of underpayments and unresolved accounts receivable.
Education and Experience
- Associate’s or Bachelor’s degree in Business, Healthcare Administration, or a related field required
- Minimum 2 years of experience in healthcare billing, accounts receivable, pharmacy operations, revenue cycle, claims adjudication, or related healthcare financial operations required
- Experience with pharmacy billing, PBM workflows, prior authorization processes, remittance reconciliation, or denial management strongly preferred
- Experience interpreting EOBs, claim edits, payment variances, or 835 remittance transactions preferred
- Experience working within Epic, electronic health records, pharmacy systems, or healthcare financial systems preferred
- Prior retail pharmacy, ambulatory pharmacy, managed care, health information management, or healthcare reimbursement experience preferred
Certification and Licensure
- NJ Pharmacy Technician License required within 180 days
- Certified Pharmacy Technician (PTCB, NHA, or ASHP/ACPE) required
- RHIT/RHIA or Coding Certification (CCS, CPC, COC) required
- PTCB Billing and Reimbursement certificate preferred
Knowledge and Skills
- Strong understanding of healthcare revenue cycle processes, including claim adjudication, payment posting, and denial management
- Ability to analyze and reconcile financial transactions with high accuracy
- Proficiency in workqueue-driven workflows within electronic health record systems
- Strong problem-solving and analytical skills
- Effective communication and collaboration across operational and financial teams
Benefits information is available through Inspira Health’s benefits offerings.
Location
New Jersey, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
1 month ago