Pharmacy Services Revenue Analyst

Financial Analyst of Pharmacy Services Revenue Integrity

The Financial Analyst of Pharmacy Services Revenue Integrity supports pharmacy services financial performance across the delivery system through financial reporting, data analysis, financial planning, contract proposal evaluations, claims payment accuracy reconciliation, and pharmacy payer contract liaison activities. The Financial Analyst extracts and validates data from various information systems and provides actionable information and recommendations through advanced analytics to assist leaders in managing financial performance.

Analysis

• Analyzing proposals by monitoring payment variances, identify revenue and cost trends.
• Track contract performance against projections.
• Tracking and updating of all third party payer fee schedules, internal charge masters, and payer contracted payment methodologies.
• Reviews charge levels against third party payer contracts, summarizes findings and communicates results to manager and the revenue integrity team.
• Administer revenue capture analysis and report by validating reimbursement and investigating claims.
• Assist manager in third party payer reimbursement appeals.
• Support manager in tracking top contracts, top lines of business and payer mix.
• Ad-hoc reporting to identify third party payor populations as needed by leadership.
• Review reconciliation of claims activity identifying payment discrepancies and summarize results to Manager, Revenue Integrity Operations Team for action.
• Analyze trends to assess efficiency of business activities and recommend plan adjustments or other improvement measures to manager.
• Effectively utilizes multiple systems and applications, such as dispensing systems, spreadsheets, and graphic packages to assemble, manipulate and/or format data and reports.
• Assist in all revenue integrity operations activities to optimize support and collaboration within Revenue Integrity team.

Research

• Maintain up to date knowledge through attending educational workshops and reviewing publications.
• Develop subject matter expertise for reimbursement and contracting databases such as Inmar.
• Research common third party and health plan claim processing information to ensure accuracy in reporting using payer portal and pharmacy newsletters.
• Participates in meetings and revenue integrity projects with internal and external customers.

Required Qualifications

• B.S./B.A. Analytics, Finance, HealthCare Administration or HealthCare Insurance, Accounting, Business Management
• 1 year 1 - 3 years related experience in financial analysis - preferably with insurance company/payor including both Pharmacy Benefit Manager (PBM) and Health Plan or health care provider system.
• Proficient in Microsoft Suite applications such as Excel, Access, PowerPoint, Word

Preferred Qualifications

• 2 years 2 - 4 years experience in health care organization or health insurance company
• Certified Pharmacy Technician