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Texas Health Resources logo
Texas Health Resources

Located in Arlington Texas, Texas Health Resources is a nonprofit, faith-based healthcare provider that has been providing a wide range of healthcare services to the communities th

Pharmacy Revenue & Reimbursement Analyst

Location

United States

Posted

37 days ago

Salary

0

Seniority

Mid Level

No structured requirement data.

Job Description

Pharmacy Revenue & Reimbursement Analyst

Texas Health Resources

Role Description Bring your passion to Texas Health so we are Better + Together Work Location: Remote Work Hours: Full Time Days (8:00am-5:00pm) for 40 hrs/week (remote work allowed at manager's discretion) Department Highlights: - Gain a sense of accomplishment by contributing to a teamwork environment. - Remote Position What You Will Do: - Revenue Analysis - Facilitate and support claims processing, rebills, appeals, and follow-up with PBMs and health plans; identify appeal opportunities and manage payor communications to recover underpayments or resolve payment variances. - Monitor and report aging accounts receivable and key performance metrics (e.g., DSO, applied cash). - Support 340B revenue optimization activities by monitoring payor and accumulator impacts (where applicable), identifying claim-level variances, and collaborating with pharmacy operations and finance to resolve 340B-related reimbursement issues. - Develop reports, dashboards, and ad-hoc analysis for payment variances, denials, underpayments, and other trends to support decision-making and process improvements. - Identify trends related to denials and underpayments; collaborate with appropriate teams to implement improvement initiatives. - Payment Integrity - Analyze reimbursement from pharmacy claims to validate payment accuracy, ensure compliance with contracted rates, and reconcile claims activity with remittances to ensure payment efficacy. - Perform 340B payment integrity and audit support activities by analyzing claim-level eligibility/accumulator impacts (as applicable), researching exceptions, and preparing documentation for internal/external reviews. - Support 340B split billing and vendor processes (as applicable), including data validation, claim qualification troubleshooting, and reconciliation of replenishment/accumulation outputs. - Support maintenance of third-party payor pharmacy fee schedules, pharmacy charge masters, and contracted pharmacy payment methodologies; evaluate payor contract performance and reimbursement arrangements and support negotiations with data-driven insights. - Revenue Integrity - Provide education stakeholders to drive optimal revenue capture. - Serve as the system expert on medication-related compliance billing and charging topics. - Develop policies and/or guidelines to improve revenue integrity, charge capture, and billing compliance. - Actively research and stay current with important pharmacy billing and revenue related compliance and optimization topics to guide appropriate organizational decisions. Qualifications - Bachelor's Degree in Business, Finance, Analytics, Healthcare Administration, Accounting, or related field (Required). - Or H.S. Diploma or Equivalent with 10 Years CPhT and 10+ years of experience with pharmacy revenue cycle, retail pharmacy operations and billing, as well as 340B (Required). Requirements - 3 Years Experience in healthcare and/or pharmacy reimbursement, revenue cycle, or financial analysis; experience working with PBMs, health plans, or healthcare provider systems (Required). - Or 5 Years Pharmacy reimbursement analysis, collections, or revenue integrity experience; 340B program experience (e.g., split billing/accumulation oversight, claim qualification troubleshooting, audit support, or contract pharmacy operations) preferred. - Epic experience (Preferred). - CPhT - Certified Pharmacy Technician (Upon Hire Required). - Other ASHP Pharmacy Revenue Cycle Certificate (12 Months Required). Company Description

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