[Remote] Pharmacy Revenue & Reimbursement Analyst

Note: The job is a remote job and is open to candidates in USA. Texas Health Resources is seeking a Pharmacy Revenue & Reimbursement Analyst to contribute to their revenue cycle team. The role involves facilitating claims processing, analyzing reimbursement accuracy, and supporting 340B revenue optimization activities.

Responsibilities

• 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
• 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
• 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

Skills

• Bachelor's Degree Business, Finance, Analytics, Healthcare Administration, Accounting, or related field
• 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
• 3 Years Experience in healthcare and/or pharmacy reimbursement, revenue cycle, or financial analysis; experience working with PBMs, health plans, or healthcare provider systems
• CPhT - Certified Pharmacy Technician Upon Hire
• ASHP Pharmacy Revenue Cycle Certificate 12 Months
• 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
• 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)
• Epic Experience

Company Overview

Company H1B Sponsorship