Pharmacy Revenue Cycle Analyst

Job Summary

Focused on improving pharmacy revenue processes, the full-time Pharmacy Revenue Cycle Analyst will manage claims resolution, analyze billing practices, and ensure compliance with regulatory guidelines while working remotely.

Key responsibilities

• Research and resolve claims that have not passed payer edits, initiating actions to address rejected drug claims
• Serve as a subject matter expert for provider relationships, reimbursement issues, and claims management
• Collaborate with revenue cycle departments to improve claim denials and enhance billing accuracy

Required qualifications

• Bachelor's degree in Business, Healthcare, or a related field, or equivalent work experience
• 1 to 3 years of experience in healthcare, coding, finance, or revenue cycle management, preferably in a Medical Center setting
• Advanced knowledge of professional billing flows, coding systems, and Medicare billing guidelines
• Preferred certifications include Certified Pharmacy Technician and Coding Certification (CPC, RHIT)
• Strong analytical skills and ability to interpret medical and billing terminology