System Pharmacy Charge & Compliance Analyst

Job Description

Job Description

We are looking for a System Pharmacy Charge & Compliance Analyst to support accurate outpatient medication billing and regulatory alignment for a healthcare organization in Roseville, California. This Contract position will work closely with pharmacy, revenue cycle, compliance, and finance teams to strengthen charge integrity, reduce reimbursement risk, and improve billing accuracy across hospital outpatient settings. The ideal candidate brings strong knowledge of pharmacy charging practices, coding standards, payer expectations, and audit readiness within a hospital or health system environment.

Responsibilities:
• Review outpatient medication charges across areas such as infusion, emergency services, observation, and ambulatory procedures to confirm completeness and accuracy before claims are submitted.
• Analyze charging data, unit calculations, code relationships, and required billing modifiers to ensure claims meet payer and regulatory standards.
• Partner with pharmacy, revenue integrity, and finance teams to resolve charge discrepancies and improve charge capture performance.
• Evaluate medication billing records against clinical documentation, revenue codes, and claim form requirements to support clean outpatient claims.
• Assist with oversight of 340B-related charging practices and coordinate with program stakeholders to maintain documentation and audit preparedness.
• Investigate denials tied to drug billing, wasted medication reporting, medical necessity concerns, or coding issues and recommend corrective actions.
• Participate in internal and external review activities by gathering support materials, validating billing practices, and addressing compliance findings.
• Maintain charge master and medication file accuracy by helping update billing elements in alignment with operational workflows, payer rules, and reimbursement guidance.
• Track regulatory and payer updates affecting outpatient drug reimbursement and translate changes into billing and compliance recommendations.• At least 3 years of experience in hospital or health system pharmacy revenue integrity, billing, or compliance functions.
• Active State Pharmacy Technician license required for California, Oregon, or Hawaii, as applicable.
• High school diploma or equivalent required; additional technical or associate-level education is preferred.
• Familiarity with Epic Resolute, Cerner Revenue Cycle, or comparable billing and revenue cycle platforms is preferred.
• Working knowledge of outpatient medication charge capture, coding logic, reimbursement practices, and claim review processes.
• Understanding of payer regulations, audit standards, and healthcare compliance expectations related to hospital outpatient pharmacy billing.
• Pharmacy Technician Board certification is preferred; advanced specialty certifications such as 340B or related compliance credentials are a plus.