Pharmacy Revenue Cycle and Audit Specialist

Pharmacy Revenue Cycle and Audit Specialist Procom

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4 Chicago, IL Job Details Contract 19 hours ago Qualifications Appeals Medical insurance appeals management Data interpretation Medical claims submission Associate's degree Insurance claims appeal handling

Full Job Description Pharmacy Revenue Cycle and Audit Specialist:

On behalf of our healthcare client, Procom is searching for a Pharmacy Revenue Cycle and Audit Specialist for a contract role. This position is a hybrid position with 2 days onsite at our client's Chicago office. Pharmacy Revenue Cycle and Audit Specialist•

Job Description:

The Pharmacy Revenue Cycle and Audit Specialist is responsible for managing pharmacy reimbursement operations, third-party billing, and compliance activities for ambulatory pharmacy services. This role focuses on ensuring accurate billing, supporting audit readiness, and leading process improvements to enhance pharmacy revenue cycle performance. Pharmacy Revenue Cycle and Audit Specialist•

Responsibilities:

Perform day-to-day functions of the pharmacy revenue cycle, coordinating with pharmacy leadership. Collaborate with pharmacy operations, finance, and billing teams to resolve medication-related claim issues. Optimize insurance benefit verification, prior authorization, and appeals for pharmacy claims workflows. Process and submit accurate claims, ensuring correct usage of codes and modifiers. Manage claim rejections, denials, and underpayments; implement corrective actions. Oversee charge capture, billing workflows, and collections. Manage third-party payor audits and conduct audits of billing practices. Review claims and documentation for accuracy and compliance. Support external audits and monitor compliance with billing requirements. Monitor evolving payer policies and develop training modules. Identify and implement revenue cycle and workflow improvements. Analyze trends in denials and recommend policy updates. Provide education and training on pharmacy billing and compliance topics. Pharmacy Revenue Cycle and Audit Specialist•

Mandatory Skills:

Associate degree required. 5 years of pharmacy experience in a complex healthcare environment. Hands-on experience with claims processing and denial management. Experience with 340B programs and

HCPCS/CPT

coding. Strong analytical skills. Strong organizational skills. Strong communication skills. Pharmacy Revenue Cycle and Audit Specialist

• Nice-to-Have Skills:

  Bachelor's degree preferred. Experience with Medicare, Medicaid, and third-party payor billing. Experience in pharmacy reimbursement or billing. Problem-solving skills. Teamwork skills. Pharmacy Revenue Cycle and Audit Specialist

• Assignment Length:

  This is a contract position with a possibly of conversion to FTE. Pharmacy Revenue Cycle and Audit Specialist

• Start Date:

  ASAP. Pharmacy Revenue Cycle and Audit Specialist

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Assignment Location:

Chicago, Illinois, United States; Hybrid with 2 days in office.