Job Description:

Baptist Health is looking for a Remote Pharmacy Revenue Cycle Analyst to join our Pharmacy team!

• Ensures billing for all inpatient, outpatient commercial, Medicare, Medicaid, MCOs, and community pharmacy PBM accounts by analyzing, updating, and correcting claims data.

• Assures that billing procedures performed by the department are accurate and timely.

• Works collaboratively with accounts receivable through prompt and accurate billing, payment auditing, credits, and follow up of all patient accounts with Medicare, Medicare Advantage, Medicaid, PBMs, and MCOs.

• Coordinates with sites, managed care, and the business office to decrease medication-related claim denials, underpayments, and outstanding claims.

• Reviews, investigates, and processes high dollar and high dispense quantity work queue items.

• Serves as the system expert on medication-related compliance billing and charging.

• Performs quality reviews to ensure that pharmacy charge description master (PCDM) additions, inactivations, changes and/or revisions were accurately completed in the clinical and financial systems.

• Assists Baptist Health’s pharmacy contract negotiating team in developing and maintaining up to date, accurate payment models.

• Assists with pharmacy cost avoidance by maximizing and optimizing existing opportunities, creating new programs and services, and reducing costs.

• Collaborates with clinical staff, other departments, and physician offices to request assistance (additional documentation, coding review, etc.) when necessary to successfully appeal an account.

• Assists with contract compliance.

• Responsible for working with IT and software vendor to test and implement software upgrades related to payment modeling software.

• Works with the revenue cycle team and pharmacy leadership to develop quality metrics and audit methodologies to drive accuracy and first-time quality.

• Assists with the development and enhancement of analytical tools for prospective and retrospective audits and data analysis.

• Coordinates the overall maintenance of all pharmacy revenue cycle scorecards, dashboards and key performance indicators.

• Audits price file updates from wholesaler, non-wholesaler, Epic, charges, and patient information.

• Responsible for developing reports to highlight the proposed vs. actual financial impact by contract term.

• Provides education to site and system stakeholders to drive optimal revenue capture and compliance.

• Assists with development of policies, guidelines, and procedures for pharmaceutical coding, billing, pricing, charging, and denial management.

• Participates in committees, work groups, process improvement efforts, and educational initiatives.

QUALIFICATIONS

REQUIRED:

• Bachelor's degree.

• 3 years of work-related experience.

• 4 years of additional experience may be substituted for a degree.

• Strong knowledge of general ledger accounts and coding.

PREFERRED:

• Bachelor's degree in accounting or finance, or equivalent college level courses in accounting.

• Hospital and Community based experience with expertise in billing and compliance.

• Experience in CDM maintenance.

• Direct experience in healthcare.

If you would like to be part of a growing family focused on supporting clinical excellence, teamwork and innovation, we urge you to apply now!

Baptist Health is an Equal Employment Opportunity employer.