The Pharmacy Revenue Cycle Specialist supports comprehensive Pharmacy-related billing, charge integrity, and reimbursement operations across inpatient, outpatient retail, specialty, and infusion pharmacy services. Reporting to the Pharmacy 340B Business Manager, this role is responsible for identifying, analyzing, and resolving revenue cycle issues while ensuring accurate, compliant billing practices and optimizing reimbursement outcomes. The Analyst partners with pharmacy, finance, IT, and compliance teams to monitor data, address denials, and support pharmacy revenue operations and audits across the enterprise.

Core Job Responsibilities

Investigates, tracks, and resolves drug-related claim denials and billing exceptions across multiple sites of care.
Reviews high-cost medication charges and validates accuracy of billing against payer rules and contract terms.
Monitors daily drug charge edits, financial queues, and exception reports to identify revenue leakage or discrepancies.
Collaborates with 340B Compliance, Purchasing, and Finance teams to support accurate 340B replenishment and contract integrity.
Maintains and updates the pharmacy charge master (CDM), internal pricing structures, and drug charge tables in coordination with IT and revenue integrity.
Ensures EMR system mapping for new drug entries, billing units, and package conversions aligns with billing guidelines and payer requirements.
Utilizes pharmacy dispensing and billing systems to re-bill or correct charges.
Participates in EMR and third-party system upgrades, maintenance, and testing related to drug billing functionality.
Assists with internal and external audits (e.g., 340B, payer, revenue integrity), including data gathering, documentation, and response coordination.
Prepares reports and dashboards to track performance indicators, charge trends, and compliance metrics.
Works cross-functionally with Coding, Patient Financial Services, Compliance, and Revenue Cycle to resolve billing issues.
Identifies opportunities for quality and process improvements in drug billing, charge capture, and reimbursement workflows.
Assists with maintaining contract pharmacy billing files, split billing logic, and audit readiness under 340B guidelines.
Supports special projects and provides analytical assistance for revenue optimization initiatives.
Responds to inquiries from pharmacy and finance leadership related to reimbursement, pricing, and charge workflows.
Performs other duties as assigned.

Education/Experience Requirements

REQUIRED:

High school diploma and minimum of 5 years of experience in healthcare billing, pharmacy billing operations, or data analysis OR
Associate's degree in Business, Health Information, Pharmacy Technology, or a related field with at least 3 years of relevant experience.
Ability to travel between multiple work locations within the region.

PREFERRED:

Experience in hospital or health system revenue cycle operations.
Knowledge of 340B Drug Pricing Program, third-party payer billing guidelines, or pharmacy claims reconciliation.
Familiarity with Epic, Cerner, or other EMR platforms used for charge capture and revenue cycle management.

Licensure/Certification Requirements

PREFERRED:

Certified Pharmacy Technician (CPhT) or certification in revenue cycle/healthcare reimbursement

Disclaimer

Qualified applicants will receive consideration for employment without regard to their age, race, religion, national origin, ethnicity, age, gender (including pregnancy, childbirth, et al), sexual orientation, gender identity or expression, protected veteran status, or disability.
Successful candidates might be required to undergo a background verification with an external vendor.

Job Details

Req Id 95863
Department 340B CONTRACT PHARMACY
Shift Variable
Shift Hours Worked 8.00
FTE 1
Work Schedule HRLY NON-UNION-8 HR
Employee Status A1 - Full-Time
Union Non-Union
Pay Range $23 - $35.60 Per Hour

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