Pharmacy Revenue Specialist

Description

Pharmacy Revenue Specialist Position Summary

The Pharmacy Revenue Specialist plays a critical role in ensuring accurate and timely adjudication of pharmacy claims while supporting overall revenue cycle performance. This position requires a Pharmacy Technician license with a strong understanding of pharmacy benefit manager (PBM) processes, insurance claim workflows, and reimbursement practices. The Pharmacy Revenue Specialist ensures revenue actualization by resolving rejected claims, minimizing denials, and supporting billing integrity across pharmacy operations.

How We Take Care of our Pharmacy Revenue Specialists

Competitive, market-based compensation and benefits that include:

• Health, dental, vision insurance + ancillary choices as well 
• Teladoc services (provided at no cost)
• $50,000 Life insurance (provided at no cost)
• Employee Assistance Program (provided at no cost)
• 401K retirement + company match
• Short- & long-term disability
• 15 days paid vacation
• 8 Paid Holidays
• 40 paid volunteer hours
• Bereavement time off
• Quarterly company events

Pharmacy Revenue Specialist Essential Functions

• Process and adjudicate pharmacy claims through PBM systems to ensure timely and accurate reimbursement.
• Identify, investigate, and resolve claim rejections, denials, and underpayments in a timely manner.
• Obtain PBM prior authorizations.
• Collaborate with pharmacists, technicians, billing teams, and payers to ensure proper claim submission and follow-up.
• Monitor real-time claim performance metrics and proactively address revenue leakage.
• Ensure compliance with payer rules, regulations, and internal policies for claim submission and documentation.
• Assist in payer audits by providing claim documentation, clarification, and resolution support.
• Maintain accurate records of claim activity, adjustments, and revenue cycle performance indicators.
• Manage infusion pump coordination, including tracking, allocation, return, and documentation of devices.
• Support initiatives related to revenue cycle optimization, reimbursement integrity, and payer contract adherence.
• Provide education and support to pharmacy staff on claim adjudication best practices.

Pharmacy Revenue Specialist Essential Functions

• Active Pharmacy Technician certification (CPhT) preferred, state licensure as applicable.
• Minimum 2 years of experience in pharmacy billing, PBM claim adjudication, or related revenue cycle role.
• Strong understanding of pharmacy reimbursement processes and payer requirements.
• Proficiency with pharmacy management systems and claim adjudication platforms.
• Excellent problem-solving skills with the ability to analyze claim denials and identify solutions.
• Strong attention to detail and accuracy in claim processing and documentation.
• Effective communication and collaboration skills across clinical and administrative teams.
• Ability to work independently, prioritize tasks, and manage deadlines in a fast-paced environment

Working Conditions

This role is typically performed in a pharmacy office or healthcare administrative environment. The Pharmacy Revenue Specialist works closely with pharmacists, technicians, billing teams, and payers, requiring effective teamwork and communication. This position may require occasional extended hours during peak periods of claim processing or payer audits.

Requirements

The Barnes Difference

For those looking for a workplace that is as compassionate with its staff as it is with its patients – Barnes Healthcare has what you are looking for. Providing unparalleled service since 1909, we do not just offer you a job; we welcome you into a family committed to outstanding care, community spirit, and meaningful impact. Our history exists simply because of the people committed to delivering on our driving purpose - We Take Care of People. ™

• A Legacy of Caring - Join forces with a healthcare pioneer! Experience how we have earned the trust of countless families through over a century of unwavering dedication to nurturing health and happiness.
• A Culture of Empathy - Dive into an environment where patients' wellness journeys shape our business. Your empathy and insights are valued, heard, and pivotal in crafting holistic care experiences.
• Community Engagement - Engage with local endeavors, enrich lives, and witness firsthand the difference you make every day. We provide 40 hours of volunteer time off to allow you to get involved with our communities in a personal w