Pharmacy Revenue & Reimbursement Analyst

Pharmacy Revenue & Reimbursement Analyst

Bring your passion to Texas Health so we are Better + Together

Work Location: Remote: Texas Health Corporate, 612 E. Lamar Blvd., Arlington, TX 76011

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
• Remote 

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.
45%25
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.
35%25
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
20%25

What You Need: 

Education
Bachelor's Degree Business, Finance, Analytics, Healthcare Administration, Accounting, or related field Req Or
H.S. Diploma or Equivalent 10 Years CPhT with 10+ years of experience with pharmacy revenue cycle, retail pharmacy operations and billing, as well as 340B Req

Experience
3 Years Experience in healthcare and/or pharmacy reimbursement, revenue cycle, or financial analysis; experience working with PBMs, health plans, or healthcare provider systems. Req 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. Pref

Epic experience Preferred

Licenses and Certifications
CPhT - Certified Pharmacy Technician Upon Hire Req
Other ASHP Pharmacy Revenue Cycle Certificate 12 Months Req

Skills
Extensive knowledge of pharmacy revenue cycle processes, to include PBM contracting, and 340B program concepts such as eligibility/qualifications, split billing, accumulation, replenishment, etc.... Understanding of laws and regulations impacting pharmacy billing and 340B. Demonstrate intrapersonal skills, a positive demeanor, professional skills/approach, good verbal and written communication skills, as well as initiative and self-motivation. Must be detail oriented and have strong analytical, critical, and problem-solving skills to support leadership decision making. Possess ability to work independently, proactively with limited supervision and as a team player when called upon.

Supervision
Individual Contributor

ADA Requirements
Extreme Heat 1-33%25
Extreme Cold 1-33%25
Extreme Swings in Temperature 1-33%25
Extreme Noise 1-33%25
Working Outdoors 1-33%25
Working Indoors 1-33%25
Mechanical Hazards 1-33%25
Electrical Hazards 1-33%25
Explosive Hazards 1-33%25
Fume/Odor Hazards 1-33%25
Dust/Mites Hazards 1-33%25
Chemical Hazards 1-33%25
Toxic Waste Hazards 1-33%25
Radiation Hazards 1-33%25
Wet Hazards 1-33%25
Heights 1-33%25
Other Conditions 1-33%25

Physical Demands
Sedentary

Travel Requirements
Local 5%25 Local travel to THR facilities, as needed