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% 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% 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%