Pharmacy Revenue Cycle Analyst - Remote

Summary The Pharmacy Revenue Cycle Analyst II is responsible for ensuring optimal revenue capture for pharmacy services at Baptist Health, maximizing financial performance by monitoring revenue cycle performance, accurately capturing pharmacy charges, coding, and verifying inpatient and outpatient claims. The analyst uses coding expertise to enhance efficiency and excellence for patients and providers, ensuring adherence to pharmacy revenue cycle regulations and supporting pharmacy leadership in payment models, managed care negotiations, payment auditing, and denial management. Job Responsibilities • Ensures billing for all inpatient, outpatient commercial, Medicare, Medicaid, MCOs, and community pharmacy PBM accounts by analyzing, updating, and correcting claims data. • Assures accurate and timely billing procedures and collaborates with accounts receivable, managing payments, credits, and patient account follow‑up for all payors. • Coordinates with sites, managed care, and the business office to reduce medication‑related claim denials, underpayments, and outstanding claims. • Reviews, investigates, and processes high‑value and high‑dispense work queue items, serving as the system expert on medication‑related compliance billing and charging. • Performs quality reviews of pharmacy charge description master (PCDM) updates, ensuring accurate additions, inactivations, changes, or revisions in clinical and financial systems. • Supports Baptist Health’s pharmacy contracting team in developing and maintaining accurate payment models, reporting profitability, payor analysis, and key performance metrics. • Collaborates with clinical staff, other departments, and physician offices to request documentation or coding review needed for successful account appeals, ensuring follow‑up until resolution. • Assists with contract compliance, identifies savings opportunities, and works with IT and vendors to test and implement payment‑modeling software upgrades. • Develops quality metrics and audit methodologies for first‑time accuracy of HCPCS/CPT codes, revenue codes, billable units, multipliers, modifiers, and indications, and enhances analytical tools for audits and data analysis. • Maintains pharmacy revenue cycle scorecards, dashboards, key performance indicators, and audits price file updates from wholesalers, Epic, charges, and patient information. • Provides education to site and system stakeholders to drive optimal revenue capture and compliance, and participates in committees, work groups, process improvement efforts, and educational initiatives. Qualifications Required: Bachelor’s degree or 4 years of additional experience in lieu of a degree. Minimum 3 years of job‑related experience; 4 years of additional experience may substitute for a degree. Strong knowledge of general ledger accounts and coding. Preferred: Accounting, Finance, or equivalent college‑level courses in accounting. Home Care Specialist–Diagnosis (HCS‑D), Home Care Specialist–Oasis (HCS‑O) or Certificate for OASIS Specialist–Clinical (COS‑C). Hospital and community–based experience with billing and compliance expertise. Experience in CDM maintenance. Direct experience in healthcare. Baptist Health is an Equal Employment Opportunity employer and encourages applicants from diverse backgrounds to apply. #J-18808-Ljbffr